PENELOPE ANN EWBANK Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

ACTIVE

Business

First Name

PENELOPE

Middle

ANN

Last Name

EWBANK

Business Name

PENELOPE ANN EWBANK

Original Issue Date

07/05/2001

Effective Date

05/31/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61615

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/31/2023