NICOLE FELICE MANCHA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047727

License Status

EXPIRED

Business

First Name

NICOLE

Middle

FELICE

Last Name

MANCHA

Suffix

Business Name

NICOLE FELICE MANCHA MD

Original Issue Date

07/01/2004

Effective Date

07/01/2004

Expiration Date

06/30/2007

City

GENESEO

State

Zip

61254

County

HENRY

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

07/03/2007