BRENTON M WAYSTOUT Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****59

License Status

INACTIVE

Business

First Name

BRENTON

Middle

Last Name

WAYSTOUT

Business Name

BRENTON M WAYSTOUT

Original Issue Date

07/15/2014

Effective Date

05/14/2018

Expiration Date

09/30/2020

City

FAIRBURY

State

Zip

61739

County

LIVINGSTON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/13/2018