KHANKHAM PHOMMAVONG Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043104013

License Status

NOT RENEWED

Business

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

City

ROCK FALLS

State

Zip

61071

County

WHITESIDE

Ever Disciplined

LastModifiedDate

03/20/2013