NINA BASUG VICENTE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036056780

License Status

NOT RENEWED

Business

First Name

NINA BASUG

Last Name

VICENTE

Suffix

Business Name

NINA BASUG VICENTE MD

Original Issue Date

05/19/1978

Effective Date

05/19/1978

Expiration Date

07/31/1993

City

BROOKFIELD

State

Zip

53005

County

WISCONSIN

Ever Disciplined

LastModifiedDate

09/20/2006