DENISE EVELENE KISELY MARTIN Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****05

License Status

NOT RENEWED

Business

First Name

DENISE

Middle

EVELENE KISELY

Last Name

MARTIN

Business Name

DENISE EVELENE KISELY MARTIN

Original Issue Date

04/22/2019

Effective Date

04/22/2019

Expiration Date

09/30/2020

City

ROCKFORD

State

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021