NICOLE DIANE NELSON - Physician Assistant License in Illinois | # 085002390

NICOLE DIANE NELSON

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002390

License Status

NOT RENEWED

Business

N

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

State

IL

Ever Disciplined

N

LastModifiedDate

06/06/2007