BOONCHOM PHUTAWON - Registered Nurse License in Illinois | # 041173747

BOONCHOM PHUTAWON

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041173747

License Status

NOT RENEWED

Business

N

First Name

BOONCHOM

Last Name

PHUTAWON

Business Name

BOONCHOM PHUTAWON

Original Issue Date

05/12/1977

Effective Date

04/08/2010

Expiration Date

05/31/2012

State

IL

Ever Disciplined

N

LastModifiedDate

07/10/2012