FARZANEH MOH ENTEZARI Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****28

License Status

ACTIVE

Business

First Name

FARZANEH

Middle

MOH

Last Name

ENTEZARI

Business Name

FARZANEH MOH ENTEZARI

Original Issue Date

06/28/2022

Effective Date

05/04/2024

Expiration Date

05/31/2026

City

CHAMPAIGN

State

Zip

61822

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026