STEPHANIE R KENNEDY-MALLUM 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

STEPHANIE

Middle

Last Name

KENNEDY-MALLUM

Business Name

STEPHANIE R KENNEDY-MALLUM

Original Issue Date

01/20/2021

Effective Date

03/13/2026

Expiration Date

05/31/2028

City

SKOKIE

State

Zip

60077

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/13/2026