TED STEVEN PETERSON Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****39

License Status

ACTIVE

Business

First Name

TED

Middle

STEVEN

Last Name

PETERSON

Business Name

TED STEVEN PETERSON

Original Issue Date

11/09/2021

Effective Date

06/24/2024

Expiration Date

05/31/2026

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026