SHANNELLE SUSANNE RICO MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093151

License Status

INACTIVE

Business

First Name

SHANNELLE

Middle

SUSANNE

Last Name

RICO

Suffix

Business Name

SHANNELLE SUSANNE RICO MD

Original Issue Date

06/08/1996

Effective Date

06/08/1996

Expiration Date

07/31/2002

City

RAPID CITY

State

Zip

57701

Ever Disciplined

LastModifiedDate

01/31/2019