NICHOLE S SUCKOW Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****45

License Status

ACTIVE

Business

First Name

NICHOLE

Middle

Last Name

SUCKOW

Business Name

NICHOLE S SUCKOW

Original Issue Date

01/29/2004

Effective Date

02/05/2026

Expiration Date

03/01/2028

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2026