LYDIA GRACE NELSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085008914

License Status

NOT RENEWED

Business

First Name

LYDIA

Middle

GRACE

Last Name

NELSON

Business Name

LYDIA GRACE NELSON

Original Issue Date

03/05/2022

Effective Date

03/05/2022

Expiration Date

03/01/2024

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

02/05/2025