JEREMY ROBERT NICOLARSEN Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052700

License Status

EXPIRED

Business

First Name

JEREMY

Middle

ROBERT

Last Name

NICOLARSEN

Business Name

JEREMY ROBERT NICOLARSEN

Original Issue Date

06/24/2010

Effective Date

06/24/2010

Expiration Date

06/23/2011

City

SPOKANE

State

Zip

99203

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

07/19/2011