JACQUELYN D NICHOLS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006030

License Status

NOT RENEWED

Business

First Name

JACQUELYN

Middle

Last Name

NICHOLS

Business Name

JACQUELYN D NICHOLS

Original Issue Date

10/04/2016

Effective Date

02/20/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

11/24/2020