MICHELLE L BLAZEK Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****37

License Status

NOT RENEWED

Business

First Name

MICHELLE

Middle

Last Name

BLAZEK

Business Name

MICHELLE L BLAZEK

Original Issue Date

07/19/2016

Effective Date

04/21/2020

Expiration Date

08/31/2022

City

PONCHATOULA

State

Zip

70454

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/14/2022