KELLY M BROEDERDORF Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****65

License Status

ACTIVE

Business

First Name

KELLY

Middle

Last Name

BROEDERDORF

Business Name

KELLY M BROEDERDORF

Original Issue Date

08/24/2023

Effective Date

03/18/2024

Expiration Date

05/31/2026

City

WOODSTOCK

State

Zip

60098

County

LAKE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026