NICHOLAS VINCENT GUASTALLI DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125064610

License Status

CANCELLED

Business

Title

First Name

NICHOLAS

Middle

VINCENT

Last Name

GUASTALLI

Business Name

NICHOLAS VINCENT GUASTALLI DO

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/20/2014