MOLLY JANE TIESENGA Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****09

License Status

NOT RENEWED

Business

First Name

MOLLY

Middle

JANE

Last Name

TIESENGA

Business Name

MOLLY JANE TIESENGA

Original Issue Date

03/15/2019

Effective Date

05/06/2020

Expiration Date

08/31/2022

City

MAYWOOD

State

Zip

60153

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/14/2022