NICHOLAS ALLEN WAANDERS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

Title

First Name

NICHOLAS

Middle

ALLEN

Last Name

WAANDERS

Business Name

NICHOLAS ALLEN WAANDERS MD

Original Issue Date

04/29/2022

Effective Date

04/29/2022

Expiration Date

07/31/2023

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023