PHYLLIS ANN JACK Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041158234

License Status

NOT RENEWED

Business

First Name

PHYLLIS ANN

Last Name

JACK

Business Name

PHYLLIS ANN JACK

Original Issue Date

12/06/1974

Effective Date

03/19/2018

Expiration Date

09/30/2020

City

NASHVILLE

State

Zip

62263

County

WASHINGTON

Ever Disciplined

LastModifiedDate

01/14/2021