NATHAN DANA WAVLE Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036153672

License Status

NOT RENEWED

Business

First Name

NATHAN

Middle

DANA

Last Name

WAVLE

Business Name

NATHAN DANA WAVLE

Original Issue Date

07/10/2020

Effective Date

07/10/2020

Expiration Date

07/31/2023

City

BLOOMINGTON

State

Zip

47403

Ever Disciplined

LastModifiedDate

11/30/2023