THEOLA A CLARK Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041279021

License Status

NOT RENEWED

Business

First Name

THEOLA A

Last Name

CLARK

Business Name

THEOLA A CLARK

Original Issue Date

01/05/1994

Effective Date

01/05/1994

Expiration Date

05/31/2004

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/09/2006