TAMISHA L BONVILLAIN Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****79

License Status

INACTIVE

Business

First Name

TAMISHA

Middle

Last Name

BONVILLAIN

Business Name

TAMISHA L BONVILLAIN

Original Issue Date

11/13/2019

Effective Date

06/14/2024

Expiration Date

05/31/2026

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/16/2024