License holder summary

Nicole Marie Bautista is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Nicole Marie Bautista is Northwest Indiana Nephrology, P.C., 606 E. Lincolnway, Valparaiso IN 46383. This licensed professional license is current. The license was granted 07/15/2014 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

Nicole Marie Bautista
Controlled Substance Registration - Physician
License number
01074301B
Date granted
07/15/2014
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Northwest Indiana Nephrology, P.C., 606 E. Lincolnway, Valparaiso IN 46383
indianalicensing.org
ID 27721609
LAST UPDATED 2024-03-19 15:47:39 UTC

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