NICOLE MARIE PETERSON Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****04

License Status

ACTIVE

Business

First Name

NICOLE

Middle

MARIE

Last Name

PETERSON

Business Name

NICOLE MARIE PETERSON

Original Issue Date

11/03/2010

Effective Date

02/15/2026

Expiration Date

03/01/2028

City

SAVOY

State

Zip

61874

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/15/2026