NICOLE ALICE MILLER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005288

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

ALICE

Last Name

MILLER

Business Name

NICOLE ALICE MILLER

Original Issue Date

10/03/2014

Effective Date

02/18/2016

Expiration Date

03/01/2018

City

FOREST PARK

State

Zip

60130

County

COOK

Ever Disciplined

LastModifiedDate

05/10/2018