LAUREN FORMELLA BROOKS DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

Title

First Name

LAUREN

Middle

FORMELLA

Last Name

BROOKS

Business Name

LAUREN FORMELLA BROOKS DO

Original Issue Date

02/26/2020

Effective Date

02/26/2020

Expiration Date

09/30/2020

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021