NICOLE RUTH JOHNSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061008

License Status

CANCELLED

Business

Title

First Name

NICOLE

Middle

RUTH

Last Name

JOHNSON

Business Name

NICOLE RUTH JOHNSON MD

Original Issue Date

06/24/2012

Effective Date

06/24/2012

Expiration Date

06/23/2015

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

03/24/2014