NICOLE SANDRA DECOUDRES Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****65

License Status

INOPERATIVE

Business

First Name

NICOLE

Middle

SANDRA

Last Name

DECOUDRES

Business Name

NICOLE SANDRA DECOUDRES

Original Issue Date

12/07/2012

Effective Date

02/27/2014

Expiration Date

03/01/2016

City

CHICAGO

State

Zip

60631

County

COOK

Ever Disciplined

LastModifiedDate

09/23/2015