AGNIESZKA S BASTA Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****95

License Status

ACTIVE

Business

First Name

AGNIESZKA

Middle

Last Name

BASTA

Business Name

AGNIESZKA S BASTA

Original Issue Date

01/26/2018

Effective Date

03/04/2026

Expiration Date

05/31/2028

City

HINES

State

Zip

60141

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/04/2026