KATHARINE DANIELS VAN FOSSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

Title

First Name

KATHARINE

Middle

DANIELS

Last Name

VAN FOSSEN

Business Name

KATHARINE DANIELS VAN FOSSEN MD

Original Issue Date

10/01/2019

Effective Date

10/01/2019

Expiration Date

09/30/2020

City

PERU

State

Zip

61354

County

LA SALLE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021