MARVIS L CUSTER Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****64

License Status

NOT RENEWED

Business

First Name

MARVIS

Middle

Last Name

CUSTER

Business Name

MARVIS L CUSTER

Original Issue Date

03/27/2003

Effective Date

03/05/2010

Expiration Date

05/31/2012

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Ever Disciplined

LastModifiedDate

07/10/2012