NELLI A KHALLAK Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****66

License Status

NOT RENEWED

Business

First Name

NELLI

Middle

Last Name

KHALLAK

Business Name

NELLI A KHALLAK

Original Issue Date

04/18/2019

Effective Date

04/18/2019

Expiration Date

09/30/2020

City

CHICAGO RIDGE

State

Zip

60415

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021