MANISA PHOPHAIRAT BAKER Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADVANCED PRACTICE REGISTERED NURSE

License Number

209006813

License Status

INACTIVE

Business

First Name

MANISA

Middle

PHOPHAIRAT

Last Name

BAKER

Business Name

MANISA PHOPHAIRAT BAKER

Original Issue Date

10/12/2007

Effective Date

06/29/2020

Expiration Date

08/31/2022

City

SAINT JOHN

State

Zip

46373

County

INDIANA

Ever Disciplined

LastModifiedDate

06/14/2022