BRENT J CLARK Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043085646

License Status

NOT RENEWED

Business

First Name

BRENT

Middle

Last Name

CLARK

Business Name

BRENT J CLARK

Original Issue Date

11/16/2000

Effective Date

11/30/2004

Expiration Date

01/31/2007

City

PROPHETSTOWN

State

Zip

61277

County

WHITESIDE

Ever Disciplined

LastModifiedDate

03/16/2007