DIESAWIT T HANSOM Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****89

License Status

INACTIVE

Business

First Name

DIESAWIT

Middle

Last Name

HANSOM

Business Name

DIESAWIT T HANSOM

Original Issue Date

03/16/2023

Effective Date

05/23/2024

Expiration Date

05/31/2026

City

LAKE VILLA

State

Zip

60046

County

LAKE

Ever Disciplined

LastModifiedDate

06/29/2025