NICOLE MARIE MIROBALLI Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****83

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

MARIE

Last Name

MIROBALLI

Business Name

NICOLE MARIE MIROBALLI

Original Issue Date

08/30/2017

Effective Date

03/11/2019

Expiration Date

09/30/2020

City

TINLEY PARK

State

Zip

60487

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021