DIANE PHYLLIS BERGQUIST Registered Nurse License verification

Business Entity

INACTIVE

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041152498

License Status

INACTIVE

Business

First Name

DIANE PHYLLIS

Last Name

BERGQUIST

Business Name

DIANE PHYLLIS BERGQUIST

Original Issue Date

10/23/1973

Effective Date

10/23/1973

City

TOMAH

State

Zip

54660

County

WISCONSIN

Ever Disciplined

LastModifiedDate

09/27/2006