SOUPHAPHONE BOUNMYTHAVONG NICKSIC Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****51

License Status

ACTIVE

Business

First Name

SOUPHAPHONE

Middle

BOUNMYTHAVONG

Last Name

NICKSIC

Business Name

SOUPHAPHONE BOUNMYTHAVONG NICKSIC

Original Issue Date

01/09/2026

Effective Date

01/09/2026

Expiration Date

05/31/2026

City

ELGIN

State

Zip

60123

County

KANE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026