CAROL M WIERENGA MD (Credential# 560595) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is April 13, 2005. The license expiration date date is April 30, 2006. The license status is INACTIVE.
CAROL M WIERENGA MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.043013. The credential type is physician/surgeon. The effective date is April 13, 2005. The expiration date is April 30, 2006. The business address is 7883 Sears Rd, Horton, MI 49246. The current status is inactive.
| Licensee Name | CAROL M WIERENGA MD |
| Credential ID | 560595 |
| Credential Number | 1.043013 |
| Credential Type | Physician/Surgeon |
| Business Address |
7883 Sears Rd Horton MI 49246 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2004-12-22 |
| Effective Date | 2005-04-13 |
| Expiration Date | 2006-04-30 |
| Refresh Date | 2009-07-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 393157 | CSP.0036912 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2005-01-03 | 2005-01-03 - 2006-02-28 | INACTIVE |
| Street Address | 7883 SEARS RD |
| City | HORTON |
| State | MI |
| Zip Code | 49246 |
| City | HORTON |
| Zip Code | 49246 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + HORTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Carol H Lee | 326 Colonial Rd, Guilford, CT 06437 | Physician/surgeon | 2019-12-01 ~ 2020-11-30 |
| Carol A Westbrook | Po Box 444, Beverly Shores, IN 46301-0444 | Physician/surgeon | ~ |
| Carol A Ley | 3m Company, Saint Paul, MN 55144-0001 | Physician/surgeon | 2018-06-01 ~ 2019-05-31 |
| Carol A Wheeler Md | 101 Dudley St, Providence, RI 02905-2401 | Physician/surgeon | 2017-11-01 ~ 2018-10-31 |
| Carol A Pierce | 109 E. Southfield, Shreveport, LA 71105 | Physician/surgeon | 1978-08-08 ~ 1981-10-31 |
| Carol A Abbatiello Do | 52 Shallowbrook Ln, Glastonbury, CT 06033-1407 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Carol R Reed | 36 Church Ln, Westport, CT 06880-3505 | Physician/surgeon | 2018-04-01 ~ 2019-03-31 |
| Carol G Baum | 18 Hawkwood Ln, Greenwich, CT 06830-3924 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Carol J Patterson | 107 Front St, Leeds, MA 01053-9718 | Physician/surgeon | 2014-12-01 ~ 2015-12-31 |
| Carol L Cooper Md | 17 North Ave, Norwalk, CT 06851-3837 | Physician/surgeon | 2015-07-01 ~ 2016-06-30 |
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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).