JUSTIN DAVID BLYTHE JR Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****03

License Status

ACTIVE

Business

First Name

JUSTIN

Middle

DAVID

Last Name

BLYTHE

Suffix

Business Name

JUSTIN DAVID BLYTHE JR

Original Issue Date

06/20/2025

Effective Date

03/03/2026

Expiration Date

05/31/2028

City

PARK RIDGE

State

Zip

60068

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/03/2026