SUSAN C FACKLAM Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041260607

License Status

NOT RENEWED

Business

First Name

SUSAN C

Last Name

FACKLAM

Business Name

SUSAN C FACKLAM

Original Issue Date

10/30/1990

Effective Date

03/05/2010

Expiration Date

05/31/2012

City

GRAYSLAKE

State

Zip

60030

County

LAKE

Ever Disciplined

LastModifiedDate

07/10/2012