NICHOLE ANN SMITH MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067378

License Status

EXPIRED

Business

Title

First Name

NICHOLE

Middle

ANN

Last Name

SMITH

Business Name

NICHOLE ANN SMITH MD

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2018

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

10/25/2018