TIEN T PHAM Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****85

License Status

INACTIVE

Business

First Name

TIEN

Middle

Last Name

PHAM

Business Name

TIEN T PHAM

Original Issue Date

02/16/2019

Effective Date

09/15/2020

Expiration Date

05/31/2022

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

09/15/2020