MARK WADE NIELSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

First Name

MARK

Middle

WADE

Last Name

NIELSEN

Suffix

Business Name

MARK WADE NIELSEN MD

Original Issue Date

12/16/2005

Effective Date

12/16/2005

Expiration Date

07/31/2008

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011