NICOLE MARIE MASON Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****56

License Status

INOPERATIVE

Business

First Name

NICOLE

Middle

MARIE

Last Name

MASON

Business Name

NICOLE MARIE MASON

Original Issue Date

08/01/2006

Effective Date

02/08/2018

Expiration Date

03/01/2020

City

DECATUR

State

Zip

62526

County

MACON

Ever Disciplined

LastModifiedDate

12/18/2019