THEODORE C BROCK Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****82

License Status

ACTIVE

Business

First Name

THEODORE

Middle

Last Name

BROCK

Business Name

THEODORE C BROCK

Original Issue Date

11/20/2013

Effective Date

03/13/2024

Expiration Date

05/31/2026

City

SYCAMORE

State

Zip

60178

County

DEKALB

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026