TRAVIS W BROUILLETTE Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043119408

License Status

NOT RENEWED

Business

First Name

TRAVIS

Middle

Last Name

BROUILLETTE

Business Name

TRAVIS W BROUILLETTE

Original Issue Date

09/05/2014

Effective Date

09/05/2014

Expiration Date

01/31/2015

City

MAKANDA

State

Zip

62958

County

JACKSON

Ever Disciplined

LastModifiedDate

03/09/2015