NIKKI MO WYNN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060865

License Status

CANCELLED

Business

Title

First Name

NIKKI

Middle

Last Name

WYNN

Business Name

NIKKI MO WYNN MD

Original Issue Date

06/26/2012

Effective Date

06/26/2012

Expiration Date

06/25/2015

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/24/2014