MARISSA P MAHAN Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****83

License Status

ACTIVE

Business

First Name

MARISSA

Middle

Last Name

MAHAN

Prefix

Business Name

MARISSA P MAHAN

Original Issue Date

11/01/2021

Effective Date

03/22/2024

Expiration Date

05/31/2026

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026