JAY DIETRICH Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****05

License Status

ACTIVE

Business

First Name

JAY

Last Name

DIETRICH

Business Name

JAY DIETRICH

Original Issue Date

03/26/2022

Effective Date

03/07/2024

Expiration Date

05/31/2026

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026