NICHOLAS PAUL FORD Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002386

License Status

INACTIVE

Business

First Name

NICHOLAS

Middle

PAUL

Last Name

FORD

Business Name

NICHOLAS PAUL FORD

Original Issue Date

10/15/2004

Effective Date

10/15/2004

Expiration Date

03/01/2006

City

INDIANOLA

State

Zip

50125

County

IOWA

Ever Disciplined

LastModifiedDate

10/09/2006