ELLY JO FENNELL Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****76

License Status

NOT RENEWED

Business

First Name

ELLY JO

Last Name

FENNELL

Business Name

ELLY JO FENNELL

Original Issue Date

05/27/2010

Effective Date

03/13/2018

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61603

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021