KELLY A MARTIN Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****57

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

Last Name

MARTIN

Business Name

KELLY A MARTIN

Original Issue Date

02/14/2018

Effective Date

04/11/2018

Expiration Date

09/30/2020

City

GODFREY

State

Zip

62035

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021