JORDAN K MANDEVILLE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****49

License Status

ACTIVE

Business

First Name

JORDAN

Middle

Last Name

MANDEVILLE

Business Name

JORDAN K MANDEVILLE

Original Issue Date

09/22/2023

Effective Date

06/28/2024

Expiration Date

05/31/2026

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026