KIRSTEN E FANTOM Veterinarian License verification

Business Entity

ACTIVE

License Type

Veterinarian

Description

LICENSED VETERINARIAN CONTROLLED SUBSTANCE

License Number

39*****01

License Status

ACTIVE

Business

First Name

KIRSTEN

Middle

Last Name

FANTOM

Business Name

KIRSTEN E FANTOM

Original Issue Date

08/12/2024

Effective Date

01/29/2025

Expiration Date

01/31/2027

City

URBANA

State

Zip

61802

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/29/2025