KRISTINA RENEE ERICSSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****14

License Status

NOT RENEWED

Business

First Name

KRISTINA

Middle

RENEE

Last Name

ERICSSON

Suffix

Business Name

KRISTINA RENEE ERICSSON MD

Original Issue Date

05/31/2011

Effective Date

06/26/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

01/14/2021