CONNIE HARPER REQUARTH Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****00

License Status

INACTIVE

Business

First Name

CONNIE HARPER

Last Name

REQUARTH

Business Name

CONNIE HARPER REQUARTH

Original Issue Date

08/02/2001

Effective Date

03/01/2018

Expiration Date

09/30/2020

City

DECATUR

State

Zip

62526

County

MACON

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/29/2018