NICOLE M GWIZDALA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001608

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

Last Name

GWIZDALA

Business Name

NICOLE M GWIZDALA

Original Issue Date

07/17/2001

Effective Date

07/17/2001

Expiration Date

03/01/2006

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/09/2006