JEREMY ROBERT NICOLARSEN - Medical Doctor License in Washington | # 125052700

JEREMY ROBERT NICOLARSEN

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052700

License Status

EXPIRED

Business

N

First Name

JEREMY

Middle

ROBERT

Last Name

NICOLARSEN

Business Name

JEREMY ROBERT NICOLARSEN

Original Issue Date

06/24/2010

Effective Date

06/24/2010

Expiration Date

06/23/2011

State

WA

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

N

LastModifiedDate

07/19/2011