TARA L CRUMBLE Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****00

License Status

NOT RENEWED

Business

First Name

TARA

Middle

Last Name

CRUMBLE

Business Name

TARA L CRUMBLE

Original Issue Date

11/26/2012

Effective Date

05/15/2018

Expiration Date

09/30/2020

City

METROPOLIS

State

Zip

62960

County

MASSAC

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021