DIANE MARIE KELLEY Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****18

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

MARIE

Last Name

KELLEY

Business Name

DIANE MARIE KELLEY

Original Issue Date

03/08/2019

Effective Date

03/08/2019

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61107

County

ADAMS

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021