NICHOLAS N NISSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

NOT RENEWED

Business

First Name

NICHOLAS N

Last Name

NISSEN

Suffix

Business Name

NICHOLAS N NISSEN MD

Original Issue Date

09/03/1993

Effective Date

09/03/1993

Expiration Date

07/31/1999

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006