JUDITH A DANSIZEN Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****61

License Status

INACTIVE

Business

First Name

JUDITH

Middle

Last Name

DANSIZEN

Business Name

JUDITH A DANSIZEN

Original Issue Date

10/05/2006

Effective Date

03/15/2018

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61603

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/15/2018