DWAYNE ALAN NELSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002974

License Status

NOT RENEWED

Business

First Name

DWAYNE

Middle

ALAN

Last Name

NELSON

Business Name

DWAYNE ALAN NELSON

Original Issue Date

06/21/2007

Effective Date

02/24/2010

Expiration Date

03/01/2012

City

DEKALB

State

Zip

60115

County

DEKALB

Ever Disciplined

LastModifiedDate

04/11/2012