AJIE JIBU MAMMARAPPALLIL Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****71

License Status

ACTIVE

Business

First Name

AJIE

Middle

JIBU

Last Name

MAMMARAPPALLIL

Business Name

AJIE JIBU MAMMARAPPALLIL

Original Issue Date

06/03/2021

Effective Date

03/02/2026

Expiration Date

05/31/2028

City

CHICAGO RIDGE

State

Zip

60415

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026