MITZIE NICOLA REAGAN Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****31

License Status

NOT RENEWED

Business

First Name

MITZIE

Middle

NICOLA

Last Name

REAGAN

Business Name

MITZIE NICOLA REAGAN

Original Issue Date

09/22/2017

Effective Date

10/16/2018

Expiration Date

09/30/2020

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021