MARY E FULLER Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****07

License Status

ACTIVE

Business

First Name

MARY

Middle

Last Name

FULLER

Business Name

MARY E FULLER

Original Issue Date

09/03/2020

Effective Date

05/21/2024

Expiration Date

05/31/2026

City

GENESEO

State

Zip

61254

County

HENRY

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026