MICHELLE RAE SLACK Nursing Home Administrator License verification

Business Entity

EXPIRED

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR TEMPORARY

License Number

045002993

License Status

EXPIRED

Business

First Name

MICHELLE

Middle

RAE

Last Name

SLACK

Business Name

MICHELLE RAE SLACK

Original Issue Date

01/13/2004

Effective Date

12/17/2004

Expiration Date

01/12/2005

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/04/2018