LOGAN M KLOCKNER Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****47

License Status

ACTIVE

Business

First Name

LOGAN

Middle

Last Name

KLOCKNER

Business Name

LOGAN M KLOCKNER

Original Issue Date

03/11/2021

Effective Date

05/26/2024

Expiration Date

05/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026