BRIAN L KOONTZ Nursing Home Administrator License verification

Business Entity

INACTIVE

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR TEMPORARY

License Number

045003637

License Status

INACTIVE

Business

First Name

BRIAN

Middle

Last Name

KOONTZ

Business Name

BRIAN L KOONTZ

Original Issue Date

02/28/2012

Effective Date

02/28/2012

Expiration Date

02/28/2013

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

NON LIMITED

Ever Disciplined

LastModifiedDate

02/03/2012