WILAIVAN PONGUDOM Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041153147

License Status

NOT RENEWED

Business

First Name

WILAIVAN

Last Name

PONGUDOM

Business Name

WILAIVAN PONGUDOM

Original Issue Date

12/14/1973

Effective Date

03/11/2008

Expiration Date

05/31/2010

City

LINCOLNWOOD

State

Zip

60712

County

COOK

Ever Disciplined

LastModifiedDate

08/16/2010