JENNIFER L DERRICKSON Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****81

License Status

ACTIVE

Business

First Name

JENNIFER L

Last Name

DERRICKSON

Business Name

JENNIFER L DERRICKSON

Original Issue Date

07/23/2024

Effective Date

03/04/2026

Expiration Date

05/31/2028

City

MATTOON

State

Zip

61938

County

COLES

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/04/2026