SANDRA L ETTEMA Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

ACTIVE

Business

First Name

SANDRA L

Last Name

ETTEMA

Business Name

SANDRA L ETTEMA

Original Issue Date

05/22/2007

Effective Date

05/23/2023

Expiration Date

07/31/2026

City

MATTOON

State

Zip

61938

County

COLES

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/23/2023