STACY M MODER Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043103352

License Status

NOT RENEWED

Business

First Name

STACY

Middle

Last Name

MODER

Business Name

STACY M MODER

Original Issue Date

04/05/2007

Effective Date

01/31/2011

Expiration Date

01/31/2013

City

SOUTH BELOIT

State

Zip

61080

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

03/20/2013