NICOLE POYTHRESS WATERS DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125073583

License Status

CANCELLED

Business

Title

First Name

NICOLE

Middle

POYTHRESS

Last Name

WATERS

Business Name

NICOLE POYTHRESS WATERS DO

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2022

City

MARION

State

Zip

62959

County

WILLIAMSON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/25/2019