STEPHANIE A FAZLIBASIC Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****14

License Status

INACTIVE

Business

First Name

STEPHANIE

Middle

Last Name

FAZLIBASIC

Business Name

STEPHANIE A FAZLIBASIC

Original Issue Date

01/08/2019

Effective Date

08/07/2022

Expiration Date

05/31/2024

City

OAK BROOK

State

Zip

60523

County

DUPAGE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/03/2024