STACY MARIE ROTH 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

STACY

Middle

MARIE

Last Name

ROTH

Business Name

STACY MARIE ROTH

Original Issue Date

10/28/2014

Effective Date

04/04/2024

Expiration Date

05/31/2026

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026