DIANE L DESTEFANO Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****26

License Status

INACTIVE

Business

First Name

DIANE

Middle

Last Name

DESTEFANO

Business Name

DIANE L DESTEFANO

Original Issue Date

07/26/2012

Effective Date

03/30/2018

Expiration Date

09/30/2020

City

MOUNT CARMEL

State

Zip

62863

County

WABASH

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/29/2018