JENNIFER M TARVESTAD Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****30

License Status

NOT RENEWED

Business

First Name

JENNIFER

Middle

Last Name

TARVESTAD

Business Name

JENNIFER M TARVESTAD

Original Issue Date

10/11/2018

Effective Date

10/11/2018

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021