NICHOLAS HANNUM VON BERGEN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

ACTIVE

Business

Title

First Name

NICHOLAS

Middle

HANNUM

Last Name

VON BERGEN

Business Name

NICHOLAS HANNUM VON BERGEN MD

Original Issue Date

08/08/2016

Effective Date

05/17/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/17/2023