PHENIQUE D LAKE Registered Nurse License verification

Business Entity

ACTIVE

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041492866

License Status

ACTIVE

Business

First Name

PHENIQUE

Middle

Last Name

LAKE

Business Name

PHENIQUE D LAKE

Original Issue Date

03/10/2020

Effective Date

03/22/2026

Expiration Date

05/31/2028

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

03/22/2026