MICHAEL T BANTA Registered Nurse License verification

Business Entity

INACTIVE

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043100082

License Status

INACTIVE

Business

First Name

MICHAEL

Middle

Last Name

BANTA

Business Name

MICHAEL T BANTA

Original Issue Date

07/15/2005

Effective Date

12/10/2008

Expiration Date

01/31/2011

City

QUINCY

State

Zip

62301

County

ADAMS

Ever Disciplined

LastModifiedDate

11/03/2010