NICOLE J GALLOB Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****71

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

Last Name

GALLOB

Business Name

NICOLE J GALLOB

Original Issue Date

11/28/2006

Effective Date

11/28/2006

Expiration Date

03/01/2008

City

SYCAMORE

State

Zip

60178

County

DEKALB

Ever Disciplined

LastModifiedDate

01/11/2011