LAURA BETH PETHAN Advanced Practice Nurse License verification

Business Entity

INOPERATIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****90

License Status

INOPERATIVE

Business

First Name

LAURA

Middle

BETH

Last Name

PETHAN

Business Name

LAURA BETH PETHAN

Original Issue Date

11/24/2014

Effective Date

04/10/2016

Expiration Date

05/31/2018

City

ROCKFORD

State

Zip

61102

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

03/01/2018