NICK NICOLAEV NICOLOFF Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****52

License Status

NOT RENEWED

Business

First Name

NICK

Middle

NICOLAEV

Last Name

NICOLOFF

Business Name

NICK NICOLAEV NICOLOFF

Original Issue Date

01/24/2002

Effective Date

03/18/2014

Expiration Date

03/01/2016

City

HIGHLAND PARK

State

Zip

60035

County

LAKE

Ever Disciplined

LastModifiedDate

02/09/2018