NICOLE E BACK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****79

License Status

ACTIVE

Business

First Name

NICOLE

Middle

Last Name

BACK

Business Name

NICOLE E BACK

Original Issue Date

08/12/2016

Effective Date

01/15/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60657

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/15/2026