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KSBHA
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City Search Results
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[1] results found
| JOHN DOE |
| Personal Information |
License Information |
| Address: |
123 Mockingbird Ln. |
License Number: |
1234 |
| City: |
City |
Status: |
Active |
| State: |
KS |
Expiration Date: |
12/31/2008 |
| Zip: |
12345 |
Last Renewal: |
12/31/2004 |
| Phone Number: |
555-555-5555 |
Original License Date: |
08/21/1998 |
| Fax Number: |
555-555-6666 |
Date Cancelled: |
|
| School Name: |
School |
Temporary Permit: |
NA |
| Degree Date: |
05/21/1994 |
Temporary Permit Expiration: |
|
| Profession: |
Nurse Practitioner |
Cont. Education Year: |
|
| Specialty: |
Prenatal Care |
Disciplinary Action: |
None |
| Date of Birth: |
12/06/1968 |
Data Updated: |
|
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