NANCY C BRADDOCK Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****57

License Status

INOPERATIVE

Business

First Name

NANCY

Middle

Last Name

BRADDOCK

Business Name

NANCY C BRADDOCK

Original Issue Date

09/15/2003

Effective Date

02/23/2018

Expiration Date

03/01/2020

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

12/18/2019