ALEXANDRA NICOLE THEISEN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

ACTIVE

Business

Title

First Name

ALEXANDRA

Middle

NICOLE

Last Name

THEISEN

Business Name

ALEXANDRA NICOLE THEISEN MD

Original Issue Date

06/24/2022

Effective Date

07/16/2023

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63108

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/16/2023