SOUPHAPHONE BOUNMYTHAVONG NICKSIC - Advanced Practice Nurse License in Illinois | # 209008677

SOUPHAPHONE BOUNMYTHAVONG NICKSIC

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADVANCED PRACTICE REGISTERED NURSE

License Number

209008677

License Status

ACTIVE

Business

N

First Name

SOUPHAPHONE

Middle

BOUNMYTHAVONG

Last Name

NICKSIC

Business Name

SOUPHAPHONE BOUNMYTHAVONG NICKSIC

Original Issue Date

02/18/2011

Effective Date

04/01/2026

Expiration Date

05/31/2028

State

IL

Ever Disciplined

N

LastModifiedDate

04/01/2026