DOMINIQUE R ELY Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****19

License Status

ACTIVE

Business

First Name

DOMINIQUE

Middle

Last Name

ELY

Business Name

DOMINIQUE R ELY

Original Issue Date

02/21/2014

Effective Date

04/18/2024

Expiration Date

05/31/2026

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026