NICHOLAS VINCENT GUASTALLI DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

ACTIVE

Business

Title

First Name

NICHOLAS

Middle

VINCENT

Last Name

GUASTALLI

Business Name

NICHOLAS VINCENT GUASTALLI DO

Original Issue Date

06/20/2017

Effective Date

05/02/2023

Expiration Date

07/31/2026

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2023