NICHOLAS TYLER WALSH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****99

License Status

NOT RENEWED

Business

First Name

NICHOLAS

Middle

TYLER

Last Name

WALSH

Business Name

NICHOLAS TYLER WALSH

Original Issue Date

09/27/2019

Effective Date

12/24/2019

Expiration Date

03/01/2022

City

OAK LAWN

State

Zip

60453

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022