MARIE A FORTMAN Registered Nurse License verification

Business Entity

INACTIVE

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043072807

License Status

INACTIVE

Business

First Name

MARIE A

Last Name

FORTMAN

Business Name

MARIE A FORTMAN

Original Issue Date

12/23/1992

Effective Date

10/26/2000

Expiration Date

01/31/2001

City

ROCKFORD

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/15/2005