TANNA LYNN MCCULLOUGH Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****30

License Status

INACTIVE

Business

First Name

TANNA

Middle

LYNN

Last Name

MCCULLOUGH

Business Name

TANNA LYNN MCCULLOUGH

Original Issue Date

09/14/2007

Effective Date

05/13/2024

Expiration Date

05/31/2026

City

BRIDGEPORT

State

Zip

62417

County

LAWRENCE

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

09/27/2024