TANISHA LYNN MCCULLOUGH Nursing Home Administrator License verification

Business Entity

CANCELLED

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR TEMPORARY

License Number

045003901

License Status

CANCELLED

Business

First Name

TANISHA

Middle

LYNN

Last Name

MCCULLOUGH

Business Name

TANISHA LYNN MCCULLOUGH

Original Issue Date

12/09/2015

Effective Date

09/15/2016

Expiration Date

09/15/2017

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/17/2016