BRADLEY WAYNE GRISSOM 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

BRADLEY

Middle

WAYNE

Last Name

GRISSOM

Business Name

BRADLEY WAYNE GRISSOM

Original Issue Date

10/06/2005

Effective Date

04/25/2024

Expiration Date

05/31/2026

City

BISMARCK

State

Zip

61814

County

VERMILION

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026