SHANNON K FORTH Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043100553

License Status

NOT RENEWED

Business

First Name

SHANNON

Middle

Last Name

FORTH

Business Name

SHANNON K FORTH

Original Issue Date

10/05/2005

Effective Date

10/05/2005

Expiration Date

01/31/2007

City

JOHNSONVILLE

State

Zip

62850

County

WAYNE

Ever Disciplined

LastModifiedDate

03/16/2007