TOWANDA SHANTA HARRIS-FULLER Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****65

License Status

ACTIVE

Business

First Name

TOWANDA

Middle

SHANTA

Last Name

HARRIS-FULLER

Business Name

TOWANDA SHANTA HARRIS-FULLER

Original Issue Date

04/27/2006

Effective Date

04/05/2023

Expiration Date

07/31/2026

City

DUNLAP

State

Zip

61525

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/31/2023