SHANON RENEE LACY DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036160719

License Status

ACTIVE

Business

Title

First Name

SHANON

Middle

RENEE

Last Name

LACY

Business Name

SHANON RENEE LACY DO

Original Issue Date

05/31/2022

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

WEST ALLIS

State

Zip

53227

Ever Disciplined

LastModifiedDate

04/08/2023