LACEY M MANIMALA Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****44

License Status

ACTIVE

Business

First Name

LACEY

Middle

Last Name

MANIMALA

Business Name

LACEY M MANIMALA

Original Issue Date

12/10/2024

Effective Date

12/10/2024

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60639

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026