SUSAN A MACK Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****42

License Status

INACTIVE

Business

First Name

SUSAN A

Last Name

MACK

Business Name

SUSAN A MACK

Original Issue Date

07/12/2004

Effective Date

03/22/2018

Expiration Date

09/30/2020

City

DES PLAINES

State

Zip

60016

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/21/2018