MICHAEL G BONIFACIO Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****31

License Status

ACTIVE

Business

First Name

MICHAEL

Middle

Last Name

BONIFACIO

Business Name

MICHAEL G BONIFACIO

Original Issue Date

11/13/2023

Effective Date

03/03/2026

Expiration Date

05/31/2028

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/03/2026