KELLIE J GIBBONS Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****61

License Status

NOT RENEWED

Business

First Name

KELLIE

Middle

Last Name

GIBBONS

Business Name

KELLIE J GIBBONS

Original Issue Date

02/04/2011

Effective Date

04/25/2018

Expiration Date

09/30/2020

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021