SALLIE ANNE VAN BLARICUM 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

SALLIE

Middle

ANNE

Last Name

VAN BLARICUM

Business Name

SALLIE ANNE VAN BLARICUM

Original Issue Date

12/02/2021

Effective Date

04/02/2024

Expiration Date

05/31/2026

City

FLORA

State

Zip

62839

County

CLAY

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026