DIANE M KOCH Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****06

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

Last Name

KOCH

Business Name

DIANE M KOCH

Original Issue Date

09/19/2001

Effective Date

03/29/2018

Expiration Date

09/30/2020

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021