TINA RENEE ENTWISTLE DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****20

License Status

NOT RENEWED

Business

First Name

TINA

Middle

RENEE

Last Name

ENTWISTLE

Suffix

DPM

Business Name

TINA RENEE ENTWISTLE DPM

Original Issue Date

08/20/2004

Effective Date

11/08/2020

Expiration Date

01/31/2023

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/31/2023