BRIAN G BLAKE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****08

License Status

ACTIVE

Business

First Name

BRIAN

Middle

Last Name

BLAKE

Business Name

BRIAN G BLAKE

Original Issue Date

09/03/2023

Effective Date

05/20/2024

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60612

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026