KIMBERLY SMALLWOOD PUTCHAVEN Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****18

License Status

INACTIVE

Business

First Name

KIMBERLY

Last Name

SMALLWOOD PUTCHAVEN

Business Name

KIMBERLY SMALLWOOD PUTCHAVEN

Original Issue Date

10/21/2009

Effective Date

05/16/2024

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60654

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/05/2025