NANCY C BRADDOCK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002020

License Status

NOT RENEWED

Business

First Name

NANCY

Middle

Last Name

BRADDOCK

Business Name

NANCY C BRADDOCK

Original Issue Date

07/02/2003

Effective Date

02/23/2018

Expiration Date

03/01/2020

City

SAINT LOUIS

State

Zip

63139

Ever Disciplined

LastModifiedDate

11/24/2020