NICHOLAS GURGANIOUS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****68

License Status

NOT RENEWED

Business

First Name

NICHOLAS

Last Name

GURGANIOUS

Business Name

NICHOLAS GURGANIOUS

Original Issue Date

07/05/2019

Effective Date

02/05/2020

Expiration Date

03/01/2022

City

NORMAL

State

Zip

61761

County

MCLEAN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022