WENDY L VAN ITTERSUM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

NOT RENEWED

Business

First Name

WENDY

Middle

Last Name

VAN ITTERSUM

Business Name

WENDY L VAN ITTERSUM

Original Issue Date

12/07/2005

Effective Date

12/07/2005

Expiration Date

07/31/2008

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008