PHYLLIS K ROTH Advanced Practice Nurse License verification

Business Entity

CANCELLED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****29

License Status

CANCELLED

Business

First Name

PHYLLIS K

Last Name

ROTH

Business Name

PHYLLIS K ROTH

Original Issue Date

09/19/2001

Effective Date

09/19/2001

Expiration Date

05/31/2006

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

09/28/2006