NICOLE MARIE FORTUNA DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

ACTIVE

Business

Title

First Name

NICOLE

Middle

MARIE

Last Name

FORTUNA

Business Name

NICOLE MARIE FORTUNA DO

Original Issue Date

08/30/2023

Effective Date

08/30/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/30/2023