License holder summary

SHANNON DAISY COSTNER is a Board Of Medicine licensed to practice in Idaho. The address on file for SHANNON DAISY COSTNER is 3473 E SHERGAR CT Meridian ID 83642. This licensed professional license is not current. The license was granted 12/16/1997 and expired on 06/30/2006.

Idaho

Division of Occupational and Professional Licenses

SHANNON DAISY COSTNER
Board Of Medicine
License number
LRT-680
Date granted
12/16/1997
Date expires
06/30/2006
Class
Board Of Medicine
Status
Canceled
Address
3473 E SHERGAR CT Meridian ID 83642
idaholicensing.com
ID 48360193
LAST UPDATED 2024-04-03 03:16:34 UTC

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