NICOLE M SKALOUD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002420

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

Last Name

SKALOUD

Business Name

NICOLE M SKALOUD

Original Issue Date

11/30/2004

Effective Date

11/30/2004

Expiration Date

03/01/2006

City

LOMBARD

State

Zip

60148

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/09/2006