NICOLE MARIE LARSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****63

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

MARIE

Last Name

LARSON

Business Name

NICOLE MARIE LARSON

Original Issue Date

08/04/2006

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

08/11/2008