MATT T VATANATUNYAKUM Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****04

License Status

ACTIVE

Business

First Name

MATT

Middle

Last Name

VATANATUNYAKUM

Business Name

MATT T VATANATUNYAKUM

Original Issue Date

10/06/2023

Effective Date

03/03/2026

Expiration Date

05/31/2028

City

CHICAGO

State

Zip

60612

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/03/2026