M W NUGEN Athletics Professional License verification

Business Entity

NOT RENEWED

License Type

Athletics Professional

Description

ATHLETICS - LICENSED PHYSICIAN

License Number

002020157-0002

License Status

NOT RENEWED

Business

First Name

M W

Last Name

NUGEN

Business Name

M W NUGEN

Original Issue Date

02/18/1976

Effective Date

02/18/1976

Expiration Date

02/18/1977

City

PEORIA HEIGHTS

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

09/18/2006