NICOLE T MANECKE Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001851

License Status

INACTIVE

Business

First Name

NICOLE

Middle

Last Name

MANECKE

Business Name

NICOLE T MANECKE

Original Issue Date

08/19/2002

Effective Date

08/19/2002

Expiration Date

03/01/2008

City

MINNEAPOLIS

State

Zip

55405

Ever Disciplined

LastModifiedDate

12/14/2007