MARTIN KEITH HAM Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043106501

License Status

NOT RENEWED

Business

First Name

MARTIN

Middle

KEITH

Last Name

HAM

Business Name

MARTIN KEITH HAM

Original Issue Date

09/09/2008

Effective Date

01/31/2011

Expiration Date

01/31/2013

City

BUSHNELL

State

Zip

61422

County

MCDONOUGH

Ever Disciplined

LastModifiedDate

03/20/2013

Case Number

2010003653

Action

Reprimand

Discipline Start Date

04/20/2011

Discipline Reason

for failure to report his termination of employment for his mishandling of a resident who was physically aggressive with staff.