COURTNEY N FORMAN Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****64

License Status

INACTIVE

Business

First Name

COURTNEY

Middle

Last Name

FORMAN

Business Name

COURTNEY N FORMAN

Original Issue Date

09/23/2016

Effective Date

05/09/2024

Expiration Date

05/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/31/2025