PHYLLIS D WILLE Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****72

License Status

INACTIVE

Business

First Name

PHYLLIS D

Last Name

WILLE

Business Name

PHYLLIS D WILLE

Original Issue Date

07/16/2009

Effective Date

03/13/2018

Expiration Date

09/30/2020

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/08/2020