KEVIN SAMUEL MARTIN Advanced Practice Nurse License verification

Business Entity

INOPERATIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****39

License Status

INOPERATIVE

Business

First Name

KEVIN

Middle

SAMUEL

Last Name

MARTIN

Business Name

KEVIN SAMUEL MARTIN

Original Issue Date

11/12/2014

Effective Date

11/12/2014

Expiration Date

05/31/2016

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Ever Disciplined

LastModifiedDate

03/16/2016