PAUL S HAVRILKA III Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****67

License Status

INACTIVE

Business

First Name

PAUL

Middle

Last Name

HAVRILKA III

Business Name

PAUL S HAVRILKA III

Original Issue Date

03/03/2015

Effective Date

03/16/2018

Expiration Date

09/30/2020

City

WALNUT HILL

State

Zip

62893

County

MARION

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/15/2018