KEITH JAMES CERMAK Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****36

License Status

ACTIVE

Business

First Name

KEITH

Middle

JAMES

Last Name

CERMAK

Business Name

KEITH JAMES CERMAK

Original Issue Date

09/25/2013

Effective Date

03/17/2026

Expiration Date

05/31/2028

City

DECATUR

State

Zip

62545

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/17/2026