DESIREE M PROVAX 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

DESIREE

Middle

Last Name

PROVAX

Business Name

DESIREE M PROVAX

BusinessDBA

DESIREE MICHELLE PRO

Original Issue Date

04/22/2019

Effective Date

05/21/2024

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60630

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026