KEITH SAMUEL BASS Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****70

License Status

INACTIVE

Business

First Name

KEITH

Middle

SAMUEL

Last Name

BASS

Business Name

KEITH SAMUEL BASS

Original Issue Date

04/17/2017

Effective Date

08/09/2022

Expiration Date

05/31/2024

City

ANNA

State

Zip

62906

County

UNION

Ever Disciplined

LastModifiedDate

03/31/2023