MALLORY M KLOCKE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****38

License Status

ACTIVE

Business

First Name

MALLORY

Middle

Last Name

KLOCKE

Business Name

MALLORY M KLOCKE

Original Issue Date

10/30/2018

Effective Date

05/15/2024

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60660

County

COOK

Specialty/Qualifier

PRACTITIONER

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026