BRENDA JEAN NICHOLS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****21

License Status

NOT RENEWED

Business

First Name

BRENDA

Middle

JEAN

Last Name

NICHOLS

Business Name

BRENDA JEAN NICHOLS

Original Issue Date

10/25/2005

Effective Date

10/25/2005

Expiration Date

03/01/2008

City

SKOKIE

State

Zip

60076

County

COOK

Ever Disciplined

LastModifiedDate

01/31/2008