BRIAN G BLAKE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADVANCED PRACTICE REGISTERED NURSE

License Number

209022503

License Status

ACTIVE

Business

First Name

BRIAN

Middle

Last Name

BLAKE

Business Name

BRIAN G BLAKE

Original Issue Date

12/09/2020

Effective Date

05/20/2024

Expiration Date

05/31/2026

City

MOKENA

State

Zip

60448

County

WILL

Specialty/Qualifier

MASTERS

Ever Disciplined

LastModifiedDate

03/02/2026