NICHOLE MICHELE LEWIS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****66

License Status

NOT RENEWED

Business

First Name

NICHOLE

Middle

MICHELE

Last Name

LEWIS

Business Name

NICHOLE MICHELE LEWIS

Original Issue Date

01/19/2010

Effective Date

01/24/2020

Expiration Date

03/01/2022

City

BREESE

State

Zip

62230

County

CLINTON

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

07/27/2022