KHANKHAM PHOMMAVONG Registered Nurse License verification

Business Entity

INACTIVE

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041393221

License Status

INACTIVE

Business

First Name

KHANKHAM

Last Name

PHOMMAVONG

Business Name

KHANKHAM PHOMMAVONG

Original Issue Date

06/28/2011

Effective Date

03/13/2018

Expiration Date

09/30/2020

City

ROCK FALLS

State

Zip

61071

County

WHITESIDE

Ever Disciplined

LastModifiedDate

03/08/2020