HEIDI S PENA Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****25

License Status

ACTIVE

Business

First Name

HEIDI

Middle

Last Name

PENA

Business Name

HEIDI S PENA

Original Issue Date

07/18/2023

Effective Date

05/15/2024

Expiration Date

05/31/2026

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026