AGNES ANNE FENNER Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****15

License Status

ACTIVE

Business

First Name

AGNES

Middle

ANNE

Last Name

FENNER

Business Name

AGNES ANNE FENNER

Original Issue Date

10/12/2016

Effective Date

03/04/2026

Expiration Date

05/31/2028

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/04/2026