DAXA R PATEL Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****69

License Status

NOT RENEWED

Business

First Name

DAXA

Middle

Last Name

PATEL

Business Name

DAXA R PATEL

Original Issue Date

12/17/2019

Effective Date

01/02/2021

Expiration Date

08/31/2022

City

HANOVER PARK

State

Zip

60133

Delegated Controlled Substance Schedule

IV V

Ever Disciplined

LastModifiedDate

10/14/2022