KELLY L PERISIN Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****55

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

Last Name

PERISIN

Business Name

KELLY L PERISIN

Original Issue Date

06/18/2019

Effective Date

06/18/2019

Expiration Date

09/30/2020

City

DUNLAP

State

Zip

61525

County

PEORIA

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021