SHANNON LEE LUCZAK Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADVANCED PRACTICE REGISTERED NURSE

License Number

209010804

License Status

NOT RENEWED

Business

First Name

SHANNON

Middle

LEE

Last Name

LUCZAK

Business Name

SHANNON LEE LUCZAK

Original Issue Date

10/09/2013

Effective Date

04/20/2016

Expiration Date

05/31/2018

City

MISHAWAKA

State

Zip

46545

Ever Disciplined

LastModifiedDate

07/19/2018