NICOLE MARIE ROACH Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****57

License Status

ACTIVE

Business

First Name

NICOLE

Middle

MARIE

Last Name

ROACH

Business Name

NICOLE MARIE ROACH

Original Issue Date

11/10/2021

Effective Date

02/28/2024

Expiration Date

03/01/2026

City

CHICAGO

State

Zip

60657

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025