License holder summary

LISA ANNE JOHNATAKIS is a Board Of Medicine licensed to practice in Idaho. The address on file for LISA ANNE JOHNATAKIS is 1595 E PEACOCK ST MERIDIAN ID 83642. This licensed professional license is not current. The license was granted 07/14/2008 and expired on 08/01/2016.

Idaho

Division of Occupational and Professional Licenses

LISA ANNE JOHNATAKIS
Board Of Medicine
License number
LRT-1327
Date granted
07/14/2008
Date expires
08/01/2016
Class
Board Of Medicine
Status
Canceled
Address
1595 E PEACOCK ST MERIDIAN ID 83642
idaholicensing.com
ID 48335304
LAST UPDATED 2024-02-17 15:00:09 UTC

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