COURTNEY N FORMAN Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADVANCED PRACTICE REGISTERED NURSE

License Number

209014910

License Status

INACTIVE

Business

First Name

COURTNEY

Middle

Last Name

FORMAN

Business Name

COURTNEY N FORMAN

Original Issue Date

09/23/2016

Effective Date

05/09/2024

Expiration Date

05/31/2026

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

03/31/2025