BONITA G DIETRICH Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****43

License Status

INACTIVE

Business

First Name

BONITA

Middle

Last Name

DIETRICH

Business Name

BONITA G DIETRICH

Original Issue Date

06/11/2001

Effective Date

03/17/2020

Expiration Date

08/31/2022

City

PEORIA

State

Zip

61604

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/04/2022