MARIE OLIVA HENNELLY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****33

License Status

ACTIVE

Business

Title

First Name

MARIE

Middle

OLIVA

Last Name

HENNELLY

Business Name

MARIE OLIVA HENNELLY MD

Original Issue Date

06/26/2023

Effective Date

06/26/2023

Expiration Date

07/31/2026

City

CARBONDALE

State

Zip

62902

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/26/2023