GAVIN B LONGWAY Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****50

License Status

ACTIVE

Business

First Name

GAVIN

Middle

Last Name

LONGWAY

Business Name

GAVIN B LONGWAY

Original Issue Date

03/06/2023

Effective Date

03/21/2024

Expiration Date

05/31/2026

City

DALLAS

State

Zip

75249

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026