AUTUMN NICOLE CLARK Nursing Home Administrator License verification

Business Entity

EXPIRED

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR TEMPORARY

License Number

045004187

License Status

EXPIRED

Business

First Name

AUTUMN

Middle

NICOLE

Last Name

CLARK

Business Name

AUTUMN NICOLE CLARK

Original Issue Date

06/17/2019

Effective Date

06/17/2019

Expiration Date

06/17/2020

City

MC LEANSBORO

State

Zip

62859

County

HAMILTON

Ever Disciplined

LastModifiedDate

11/19/2020