TRACY MARIE DIETZ Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****88

License Status

ACTIVE

Business

First Name

TRACY

Middle

MARIE

Last Name

DIETZ

Business Name

TRACY MARIE DIETZ

Original Issue Date

02/05/2015

Effective Date

04/25/2024

Expiration Date

05/31/2026

City

EDWARDSVILLE

State

Zip

62025

County

SAINT CLAIR

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026