GILLIAN K LONG Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****70

License Status

NOT RENEWED

Business

First Name

GILLIAN

Middle

Last Name

LONG

Business Name

GILLIAN K LONG

Original Issue Date

08/22/2019

Effective Date

08/22/2019

Expiration Date

09/30/2020

City

GRANITE CITY

State

Zip

62040

County

MADISON

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021