ELIZABETH NICOLE WALLIS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036176418

License Status

ACTIVE

Business

Title

First Name

ELIZABETH

Middle

NICOLE

Last Name

WALLIS

Business Name

ELIZABETH NICOLE WALLIS MD

Original Issue Date

08/04/2025

Effective Date

08/04/2025

Expiration Date

07/31/2026

City

PRAIRIEVILLE

State

Zip

70769

Ever Disciplined

LastModifiedDate

08/04/2025