MILDRED LEE BLACK Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043035587

License Status

NOT RENEWED

Business

First Name

MILDRED LEE

Last Name

BLACK

Business Name

MILDRED LEE BLACK

Original Issue Date

09/11/1974

Effective Date

01/26/2009

Expiration Date

01/31/2011

City

SHAWNEETOWN

State

Zip

62984

County

GALLATIN

Ever Disciplined

LastModifiedDate

03/10/2011