NICOLE T MANECKE 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

MANECKE

Business Name

NICOLE T MANECKE

Original Issue Date

12/30/2002

Effective Date

12/30/2002

Expiration Date

03/01/2008

City

GURNEE

State

Zip

60031

County

LAKE

Ever Disciplined

LastModifiedDate

09/26/2006