JACQUELINE ANNE LONG Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****82

License Status

NOT RENEWED

Business

First Name

JACQUELINE ANNE

Last Name

LONG

Business Name

JACQUELINE ANNE LONG

Original Issue Date

06/19/2012

Effective Date

05/21/2022

Expiration Date

06/30/2024

City

URBANA

State

Zip

61802

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025