SOUPHAPHONE BOUNMYTHAVONG NICKSIC Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADVANCED PRACTICE REGISTERED NURSE

License Number

209008677

License Status

ACTIVE

Business

First Name

SOUPHAPHONE

Middle

BOUNMYTHAVONG

Last Name

NICKSIC

Business Name

SOUPHAPHONE BOUNMYTHAVONG NICKSIC

Original Issue Date

02/18/2011

Effective Date

04/17/2024

Expiration Date

05/31/2026

City

SOUTH ELGIN

State

Zip

60177

County

KANE

Ever Disciplined

LastModifiedDate

03/02/2026