NICOLE SERRA WILDER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

ACTIVE

Business

Title

First Name

NICOLE

Middle

SERRA

Last Name

WILDER

Business Name

NICOLE SERRA WILDER MD

Original Issue Date

03/21/2022

Effective Date

06/16/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60611

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/16/2023