CHA-GA N BULLOCK Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****61

License Status

ACTIVE

Business

First Name

CHA-GA

Middle

Last Name

BULLOCK

Business Name

CHA-GA N BULLOCK

Original Issue Date

09/27/2023

Effective Date

04/18/2024

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60643

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026