NICHOLAS STEPHEN SHEPPARD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000079

License Status

NOT RENEWED

Business

First Name

NICHOLAS STEPHEN

Last Name

SHEPPARD

Business Name

NICHOLAS STEPHEN SHEPPARD

Original Issue Date

11/05/1980

Effective Date

11/05/1980

Expiration Date

11/05/1984

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

09/26/2006