KAMALA DJUANA VIA Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****85

License Status

NOT RENEWED

Business

First Name

KAMALA

Middle

DJUANA

Last Name

VIA

Business Name

KAMALA DJUANA VIA

Original Issue Date

06/11/2018

Effective Date

06/11/2018

Expiration Date

09/30/2020

City

NORTHBROOK

State

Zip

60062

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021