MICAH DAVID Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****42

License Status

NOT RENEWED

Business

First Name

MICAH

Last Name

DAVID

Business Name

MICAH DAVID

Original Issue Date

07/24/2018

Effective Date

07/24/2018

Expiration Date

09/30/2020

City

EAST PEORIA

State

Zip

61611

County

TAZEWELL

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021