MICHELLE J LAKE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****43

License Status

ACTIVE

Business

First Name

MICHELLE

Middle

Last Name

LAKE

Business Name

MICHELLE J LAKE

Original Issue Date

10/19/2022

Effective Date

03/18/2026

Expiration Date

05/31/2028

City

PEORIA

State

Zip

61606

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/18/2026