MIRIAM JILL WHITE SULLIVAN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

MIRIAM JILL

Middle

WHITE

Last Name

SULLIVAN

Business Name

MIRIAM JILL WHITE SULLIVAN

Original Issue Date

08/31/1984

Effective Date

06/07/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021