NICOLE DANIELLE MALLORY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006904

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

DANIELLE

Last Name

MALLORY

Business Name

NICOLE DANIELLE MALLORY

Original Issue Date

12/28/2018

Effective Date

12/28/2018

Expiration Date

03/01/2020

City

MORTON GROVE

State

Zip

60053

County

COOK

Ever Disciplined

LastModifiedDate

11/24/2020