LARA WAFAA NICOLAS MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057377

License Status

EXPIRED

Business

Title

First Name

LARA

Middle

WAFAA

Last Name

NICOLAS

Business Name

LARA WAFAA NICOLAS MD

Original Issue Date

06/26/2010

Effective Date

06/26/2010

Expiration Date

06/25/2013

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

10/07/2013