MARISSA JANE VERSALLE DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****37

License Status

NOT RENEWED

Business

Title

First Name

MARISSA

Middle

JANE

Last Name

VERSALLE

Business Name

MARISSA JANE VERSALLE DO

Original Issue Date

07/26/2018

Effective Date

07/26/2018

Expiration Date

09/30/2020

City

LAKE FOREST

State

Zip

60045

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021