JUSTINE M MROSAK (Credential# 1281925) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is INACTIVE.
JUSTINE M MROSAK is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0060063. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 4516 Medina Lake Dr, Hamel, MN 55340-9375. The current status is inactive.
| Licensee Name | JUSTINE M MROSAK |
| Credential ID | 1281925 |
| Credential Number | CSP.0060063 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
4516 Medina Lake Dr Hamel MN 55340-9375 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LACK OF ACTIVE MEDICAL LICENSE |
| Issue Date | 2015-05-21 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-04-23 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1516546 | 1.061854 | Physician/Surgeon | 2018-08-30 | 2018-08-30 - 2019-08-31 | INACTIVE |
| 1488697 | 1.058092-RES | Resident Physician | 2015-06-28 | 2018-06-28 - 2019-06-30 | INACTIVE |
| Street Address | 4516 MEDINA LAKE DR |
| City | HAMEL |
| State | MN |
| Zip Code | 55340-9375 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Steven W Jantzen | 4640 Bluebell Trail N, Hamel, MN 55340 | Professional Engineer | 2016-02-01 ~ 2017-01-31 |
| Polaris Industries Inc | 2100 Hwy 55, Hamel, MN 55340 | Motor Vehicle Manufacturer (llm) | ~ |
| Dennis E Neu | 6508 Valley View Rd, Hamel, MN 55340 | Professional Engineer | 2005-02-01 ~ 2006-01-31 |
| Indian Motorcycle Company | 2100 Highway 55, Hamel, MN 55340 | Motor Vehicle Manufacturer (llm) | ~ |
| Kirk Joseph Randall | 19130 Galloway Cir, Hamel, MN 55340-3401 | Registered Nurse | 2018-08-01 ~ 2019-07-31 |
| Jennifer Kish | 1157 Jubert Trl, Medina, MN 55340-3707 | Advanced Practice Registered Nurse | 2018-06-10 ~ 2018-12-31 |
| Electrical Power & Safety Co Inc | 610 Hamel Rd, Medina, MN 55340-9612 | Professional Engineering Corporation | 2019-12-03 ~ 2020-12-03 |
| Polaris Sales Inc | 2100 Highway 55, Medina, MN 55340-9770 | Motor Vehicle Manufacturer (llm) | ~ |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Tri State Drilling | P.o. Box 252, Hamel, MN 53340 | Crane Registration | 2007-06-28 ~ 2008-06-27 |
| City | HAMEL |
| Zip Code | 55340 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + HAMEL |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Justine F. Miranda | 100 Retreat Ave, Hartford, CT 06106 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Justine Brink | 52-54 Oxford St Apt C3, Hartford, CT 06105 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Justine M Nagurney | 20 York St, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Justine Lauren Vanacore | 199 Oakland St Apt B, Manchester, CT 06042-8252 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Steven Kassels Md · Community Substance Abuse Center | Comm. Physicians PC/125 North Elm Street, Westfield, MA 01085 | Controlled Substance Registration for Practitioner | 2018-06-15 ~ 2019-02-28 |
| Shu-i Lin | CT | Controlled Substance Registration for Practitioner | 2017-06-12 ~ 2019-02-28 |
| Min Jin Kim | 639 4th Ave Apt 5c, Brooklyn, NY 11232-1048 | Controlled Substance Registration for Practitioner | 2012-05-10 ~ 2013-02-28 |
| Arundati Rao | CT | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Qi Che Md | Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2006-03-01 ~ 2007-02-28 |
| Huu Duc D Luu | 630 Mix Ave Apt 6p, Hamden, CT 06514-2320 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).