MARCUS MUTIDJO Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****63

License Status

ACTIVE

Business

First Name

MARCUS

Last Name

MUTIDJO

Business Name

MARCUS MUTIDJO

Original Issue Date

12/18/2018

Effective Date

04/21/2024

Expiration Date

05/31/2026

City

PEORIA

State

Zip

61605

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026