NICOLE DIANE NELSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002390

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

DIANE

Last Name

NELSON

Business Name

NICOLE DIANE NELSON

Original Issue Date

10/18/2004

Effective Date

10/18/2004

Expiration Date

03/01/2006

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

06/06/2007