MYSTIC LEA PARK Registered Nurse License verification

Business Entity

INACTIVE

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043104396

License Status

INACTIVE

Business

First Name

MYSTIC

Middle

LEA

Last Name

PARK

Business Name

MYSTIC LEA PARK

Original Issue Date

09/27/2007

Effective Date

01/22/2013

Expiration Date

01/31/2015

City

WATAGA

State

Zip

61488

County

KNOX

Ever Disciplined

LastModifiedDate

11/07/2014