BRANDY ANN BLACK Nursing Home Administrator License verification

Business Entity

CANCELLED

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR TEMPORARY

License Number

045003983

License Status

CANCELLED

Business

First Name

BRANDY

Middle

ANN

Last Name

BLACK

Business Name

BRANDY ANN BLACK

Original Issue Date

12/08/2016

Effective Date

11/01/2016

Expiration Date

11/01/2019

City

SPRINGFIELD

State

Zip

62703

Ever Disciplined

LastModifiedDate

12/08/2016