MARK R FORTMAN Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

REGISTERED PROFESSIONAL NURSE

License Number

041276097

License Status

NOT RENEWED

Business

First Name

MARK R

Last Name

FORTMAN

Business Name

MARK R FORTMAN

Original Issue Date

10/12/1993

Effective Date

10/12/1993

Expiration Date

05/31/1996

City

MADISON

State

Zip

62060

County

WISCONSIN

Ever Disciplined

LastModifiedDate

09/27/2006