JOHANNA V MAILLOUX
Physician/surgeon


Address: 20 South Quaker Lane, Apt. A, West Hartford, CT 06119

JOHANNA V MAILLOUX (Credential# 564244) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is October 16, 2008. The license expiration date date is October 31, 2009. The license status is INACTIVE.

Business Overview

JOHANNA V MAILLOUX is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.046662. The credential type is physician/surgeon. The effective date is October 16, 2008. The expiration date is October 31, 2009. The business address is 20 South Quaker Lane, Apt. A, West Hartford, CT 06119. The current status is inactive.

Basic Information

Licensee Name JOHANNA V MAILLOUX
Credential ID 564244
Credential Number 1.046662
Credential Type Physician/Surgeon
Business Address 20 South Quaker Lane, Apt. A
West Hartford
CT 06119
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 2008-06-23
Effective Date 2008-10-16
Expiration Date 2009-10-31
Refresh Date 2010-03-12

Office Location

Street Address 20 South Quaker Lane, Apt. A
City West Hartford
State CT
Zip Code 06119

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City West Hartford
Zip Code 06119
License Type Physician/Surgeon
License Type + County Physician/Surgeon + West Hartford

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Dataset Information

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).

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