License holder summary

LORI ANN STACKOW is a Board Of Medicine licensed to practice in Idaho. The address on file for LORI ANN STACKOW is 2170 Ironwood Center Dr. Suite A COEUR D ALENE ID 83814. This licensed professional license is not current. The license was granted 11/11/1993 and expired on 08/01/2016.

Idaho

Division of Occupational and Professional Licenses

LORI ANN STACKOW
Board Of Medicine
License number
PA-133
Date granted
11/11/1993
Date expires
08/01/2016
Class
Board Of Medicine
Status
Canceled
Address
2170 Ironwood Center Dr. Suite A COEUR D ALENE ID 83814
idaholicensing.com
ID 48356548
LAST UPDATED 2024-03-18 11:12:28 UTC

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