NICOLE KENNEBECK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085008879

License Status

ACTIVE

Business

First Name

NICOLE

Last Name

KENNEBECK

Business Name

NICOLE KENNEBECK

Original Issue Date

02/12/2022

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60607

Ever Disciplined

LastModifiedDate

02/06/2026