NICOLE M GWIZDALA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****74

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

Last Name

GWIZDALA

Business Name

NICOLE M GWIZDALA

Original Issue Date

02/13/2002

Effective Date

02/13/2002

Expiration Date

03/01/2006

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/09/2006