LONNIE POLKOW MOCH Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****97

License Status

NOT RENEWED

Business

First Name

LONNIE

Middle

POLKOW

Last Name

MOCH

Business Name

LONNIE POLKOW MOCH

Original Issue Date

03/06/2019

Effective Date

03/06/2019

Expiration Date

09/30/2020

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021