KHANKHAM PHOMMAVONG - Registered Nurse License in Illinois | # 043104013

KHANKHAM PHOMMAVONG

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043104013

License Status

NOT RENEWED

Business

N

First Name

KHANKHAM

Last Name

PHOMMAVONG

Business Name

KHANKHAM PHOMMAVONG

Original Issue Date

08/31/2007

Effective Date

12/20/2010

Expiration Date

01/31/2013

State

IL

Ever Disciplined

N

LastModifiedDate

03/20/2013