NICOLE MARIE LARSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002731

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

MARIE

Last Name

LARSON

Business Name

NICOLE MARIE LARSON

Original Issue Date

07/11/2006

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

CHICAGO

State

Zip

60605

County

COOK

Ever Disciplined

LastModifiedDate

04/01/2010