JACQUELYN D NICHOLS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****88

License Status

NOT RENEWED

Business

First Name

JACQUELYN

Middle

Last Name

NICHOLS

Business Name

JACQUELYN D NICHOLS

Original Issue Date

10/25/2016

Effective Date

02/20/2018

Expiration Date

03/01/2020

City

WESTCHESTER

State

Zip

60154

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020