MONIQUE M D'AVIS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

NOT RENEWED

Business

First Name

MONIQUE

Middle

Last Name

D'AVIS

Business Name

MONIQUE M D'AVIS

Original Issue Date

12/16/2002

Effective Date

12/16/2002

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008