VALSAMMA M EETTICKAL 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

VALSAMMA M

Last Name

EETTICKAL

Business Name

VALSAMMA M EETTICKAL

Original Issue Date

01/30/2014

Effective Date

03/20/2018

Expiration Date

09/30/2020

City

HOFFMAN ESTATES

State

Zip

60192

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021