MICHELLE VERONICA JACOB 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

MICHELLE

Middle

VERONICA

Last Name

JACOB

Business Name

MICHELLE VERONICA JACOB

Original Issue Date

01/22/2016

Effective Date

03/01/2018

Expiration Date

09/30/2020

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021