ELISSA M RUSSELL Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****12

License Status

INACTIVE

Business

First Name

ELISSA

Middle

Last Name

RUSSELL

Business Name

ELISSA M RUSSELL

Original Issue Date

09/02/2011

Effective Date

04/18/2018

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/17/2018