TARA L GUSTAFSON Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043064068

License Status

NOT RENEWED

Business

First Name

TARA

Middle

Last Name

GUSTAFSON

Business Name

TARA L GUSTAFSON

Original Issue Date

01/17/1987

Effective Date

03/04/2005

Expiration Date

01/31/2005

City

CARLYLE

State

Zip

62231

County

CLINTON

Ever Disciplined

LastModifiedDate

10/15/2005