MARILYN M LACROSSE Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

First Name

MARILYN

Middle

Last Name

LACROSSE

Business Name

MARILYN M LACROSSE

Original Issue Date

01/11/2018

Effective Date

01/11/2018

Expiration Date

09/30/2020

City

MCHENRY

State

Zip

60051

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021