NICOLE BETENIA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125069150

License Status

CANCELLED

Business

Title

First Name

NICOLE

Last Name

BETENIA

Business Name

NICOLE BETENIA MD

Original Issue Date

06/24/2019

Effective Date

06/24/2019

Expiration Date

06/23/2020

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Obstetrics and Gynecology

Ever Disciplined

LastModifiedDate

04/08/2019