JACK M PHAM Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****46

License Status

ACTIVE

Business

First Name

JACK M

Last Name

PHAM

Business Name

JACK M PHAM

Original Issue Date

06/24/2023

Effective Date

03/04/2024

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60640

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026