STACY R MARRIOTT Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****71

License Status

INACTIVE

Business

First Name

STACY

Middle

Last Name

MARRIOTT

Business Name

STACY R MARRIOTT

Original Issue Date

10/30/2019

Effective Date

05/19/2022

Expiration Date

05/31/2024

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Ever Disciplined

LastModifiedDate

05/19/2022