NICOLE DANIELLE MALLORY Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****23

License Status

INOPERATIVE

Business

First Name

NICOLE

Middle

DANIELLE

Last Name

MALLORY

Business Name

NICOLE DANIELLE MALLORY

Original Issue Date

01/07/2019

Effective Date

01/07/2019

Expiration Date

03/01/2020

City

MORTON GROVE

State

Zip

60053

Ever Disciplined

LastModifiedDate

04/20/2020