NICOLE MAE BOUNPHITHACK 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

NICOLE

Middle

MAE

Last Name

BOUNPHITHACK

Business Name

NICOLE MAE BOUNPHITHACK

Original Issue Date

10/02/2025

Effective Date

10/02/2025

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60611

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026