FREDERICK R BLOOM Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041199652

License Status

NOT RENEWED

Business

First Name

FREDERICK R

Last Name

BLOOM

Business Name

FREDERICK R BLOOM

Original Issue Date

11/17/1980

Effective Date

11/17/1980

Expiration Date

05/01/1982

City

RANTOUL

State

Zip

61866

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

09/27/2006