NICHOLAS VINCENT GUASTALLI DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036143561

License Status

ACTIVE

Business

Title

First Name

NICHOLAS

Middle

VINCENT

Last Name

GUASTALLI

Business Name

NICHOLAS VINCENT GUASTALLI DO

Original Issue Date

06/20/2017

Effective Date

05/02/2023

Expiration Date

07/31/2026

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Ever Disciplined

LastModifiedDate

05/02/2023