PHILIP S DUDAK Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****31

License Status

INACTIVE

Business

First Name

PHILIP S

Last Name

DUDAK

Business Name

PHILIP S DUDAK

Original Issue Date

02/04/2021

Effective Date

05/12/2022

Expiration Date

06/30/2024

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2024