SUSAN R WIERSMA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

NOT RENEWED

Business

First Name

SUSAN R

Last Name

WIERSMA

Suffix

Business Name

SUSAN R WIERSMA MD

Original Issue Date

09/25/1995

Effective Date

09/25/1995

Expiration Date

07/31/1999

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006