NICOLE MARIE WIRTZ Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****56

License Status

ACTIVE

Business

First Name

NICOLE

Middle

MARIE

Last Name

WIRTZ

Business Name

NICOLE MARIE WIRTZ

Original Issue Date

10/05/2010

Effective Date

01/24/2024

Expiration Date

03/01/2026

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025