NICOLE BRIANNE STAHL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006253

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

BRIANNE

Last Name

STAHL

Business Name

NICOLE BRIANNE STAHL

Original Issue Date

07/19/2017

Effective Date

01/09/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60625

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022