SUSAN A BARDWELL Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****77

License Status

NOT RENEWED

Business

First Name

SUSAN A

Last Name

BARDWELL

Business Name

SUSAN A BARDWELL

Original Issue Date

06/18/1997

Effective Date

06/18/1997

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006