SUZAN C SHANE-GRAY Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****41

License Status

NOT RENEWED

Business

First Name

SUZAN C

Last Name

SHANE-GRAY

Business Name

SUZAN C SHANE-GRAY

Original Issue Date

01/24/2011

Effective Date

05/03/2018

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61615

County

PEORIA

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021