NICHOLAS IAN ELEY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****80

License Status

NOT RENEWED

Business

First Name

NICHOLAS

Middle

IAN

Last Name

ELEY

Business Name

NICHOLAS IAN ELEY

Original Issue Date

06/17/2013

Effective Date

02/11/2016

Expiration Date

03/01/2018

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/10/2018