NICOLE MARIE WIRTZ Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003906

License Status

ACTIVE

Business

First Name

NICOLE

Middle

MARIE

Last Name

WIRTZ

Business Name

NICOLE MARIE WIRTZ

Original Issue Date

09/28/2010

Effective Date

01/24/2024

Expiration Date

03/01/2026

City

SPRINGFIELD

State

Zip

62711

Ever Disciplined

LastModifiedDate

12/03/2025