VENUS LIEZL T BASNILLO-SAN DIEGO Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****02

License Status

NOT RENEWED

Business

First Name

VENUS LIEZL

Middle

Last Name

BASNILLO-SAN DIEGO

Business Name

VENUS LIEZL T BASNILLO-SAN DIEGO

Original Issue Date

03/28/2017

Effective Date

05/15/2018

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60622

County

COOK

Delegated Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/14/2021