NICOLE DAWN BRUEGGEMANN Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****83

License Status

INOPERATIVE

Business

First Name

NICOLE

Middle

DAWN

Last Name

BRUEGGEMANN

Business Name

NICOLE DAWN BRUEGGEMANN

Original Issue Date

11/14/2019

Effective Date

01/21/2020

Expiration Date

03/01/2022

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

01/03/2022