JASON MICHAEL PENCEK Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****92

License Status

INACTIVE

Business

First Name

JASON

Middle

MICHAEL

Last Name

PENCEK

Business Name

JASON MICHAEL PENCEK

Original Issue Date

03/24/2017

Effective Date

09/02/2022

Expiration Date

05/31/2024

City

LISLE

State

Zip

60532

County

DUPAGE

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

09/02/2022