NICHOLAS MARK FENWICK Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****78

License Status

ACTIVE

Business

First Name

NICHOLAS

Middle

MARK

Last Name

FENWICK

Business Name

NICHOLAS MARK FENWICK

Original Issue Date

01/28/2022

Effective Date

03/11/2026

Expiration Date

05/31/2028

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/11/2026