NICOLE MICHELLE TABATABAI BLYTHE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****97

License Status

ACTIVE

Business

First Name

NICOLE

Middle

MICHELLE TABATABAI

Last Name

BLYTHE

Business Name

NICOLE MICHELLE TABATABAI BLYTHE

Original Issue Date

11/12/2024

Effective Date

11/12/2024

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60614

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026