MOLLY ANN VAN PETTEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

NOT RENEWED

Business

Title

First Name

MOLLY

Middle

ANN

Last Name

VAN PETTEN

Business Name

MOLLY ANN VAN PETTEN MD

Original Issue Date

05/20/2019

Effective Date

05/20/2019

Expiration Date

09/30/2020

City

JERSEYVILLE

State

Zip

62052

County

JERSEY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021