WILLIAM RANDALL PROVENCE Nursing Home Administrator License verification

Business Entity

INACTIVE

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR

License Number

044003095

License Status

INACTIVE

Business

First Name

WILLIAM RANDALL

Last Name

PROVENCE

Business Name

WILLIAM RANDALL PROVENCE

Original Issue Date

10/31/1985

Effective Date

10/07/2013

Expiration Date

11/30/2015

City

DWIGHT

State

Zip

60420

County

LIVINGSTON

Ever Disciplined

LastModifiedDate

09/04/2015