NICOLE ANN HARTSOUGH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****87

License Status

NOT RENEWED

Business

Title

First Name

NICOLE

Middle

ANN

Last Name

HARTSOUGH

Business Name

NICOLE ANN HARTSOUGH MD

Original Issue Date

08/07/2000

Effective Date

08/07/2000

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020