SHELLY L JOHNSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

First Name

SHELLY

Middle

Last Name

JOHNSEN

Suffix

Business Name

SHELLY L JOHNSEN MD

Original Issue Date

10/18/2007

Effective Date

07/10/2014

Expiration Date

07/31/2017

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017