EDWARD J RUSSOW - Registered Nurse License in Idaho | # 041342860

EDWARD J RUSSOW

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041342860

License Status

NOT RENEWED

Business

N

First Name

EDWARD

Middle

J

Last Name

RUSSOW

Business Name

EDWARD J RUSSOW

Original Issue Date

09/22/2004

Effective Date

03/11/2010

Expiration Date

05/31/2012

State

ID

Ever Disciplined

N

LastModifiedDate

07/10/2012