DIANA S WILLADSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

First Name

DIANA

Middle

Last Name

WILLADSEN

Suffix

Business Name

DIANA S WILLADSEN MD

Original Issue Date

04/08/2005

Effective Date

05/28/2014

Expiration Date

07/31/2017

City

ROCHESTER

State

Zip

62563

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017