NICK BLASE ZIOMEK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002218

License Status

NOT RENEWED

Business

First Name

NICK

Middle

BLASE

Last Name

ZIOMEK

Business Name

NICK BLASE ZIOMEK

Original Issue Date

03/04/2004

Effective Date

03/04/2004

Expiration Date

03/01/2008

City

JANESVILLE

State

Zip

53545

County

WISCONSIN

Ever Disciplined

LastModifiedDate

04/23/2008