NICK BLASE ZIOMEK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****30

License Status

NOT RENEWED

Business

First Name

NICK

Middle

BLASE

Last Name

ZIOMEK

Business Name

NICK BLASE ZIOMEK

Original Issue Date

10/17/2006

Effective Date

10/17/2006

Expiration Date

03/01/2008

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

12/03/2007