Results 1 - 10 of 11
... link and follow the instructions to search by license number or name. Once you
have located the nurse’s information you can print a copy for your records. You could provide this paper copy
in the event of an emergency, natural disaster or to obtain discounts ...
Date:
April
21, 2020
... which means that you held a Minnesota RN license and the Minnesota Board of Nursing had a current copy of your certification as an
APRN.
The undersigned does hereby affirm that the statements contained in this application are true and correct.
_________________________________
_______
Print Name
_________________________________
_______
Legal Signature
_______________________
Date (mm/dd/yyyy)
- OR -
...
Date:
April
16, 2025
... which means that you held a Minnesota RN license and the Minnesota Board of Nursing had a current copy of your certification as an
APRN.
The undersigned does hereby affirm that the statements contained in this application are true and correct.
_________________________________
_______
Print Name
_________________________________
_______
Legal Signature
_______________________
Date (mm/dd/yyyy)
- OR -
...
Date:
October
20, 2019
... Plan
START DATE
(Month/Day/Year)
ATTACH A COPY OF CURRENT LICENSE FROM BORDER STATE.
LEGAL SIGNATURE
DATE
(mm/dd/ ...
Date:
April
22, 2020
... which means that you held a Minnesota RN license and the Minnesota Board of Nursing had a current copy of your
-------
---
certification as an APRN.
___________________________________
________________
Legal Signature
___________________
...
Date:
October
20, 2019
... supply information may result in denial of a license. Falsification or omission of information
may be used by the Board as a basis for disciplinary action.
• Type or print clearly
LAST NAME
MAIDEN NAME
STREET ADDRESS
• Provide ...
Date:
April
16, 2025
... supply information may result in denial of a license. Falsification or omission of information
may be used by the Board as a basis for disciplinary action.
•
Type or print clearly
LAST NAME
MAIDEN NAME
STREET ADDRESS
•
Use ...
Date:
April
16, 2025
... by
a national nursing or medical organization. A copy of the current nursing specialty certification at the time the licensee
renewed his/her nursing license must be kept to evidence the licensee met ...
Date:
January
27, 2015
... Document damaged or destroyed
Name change.
•
Enclose a copy of legal proof of name change, such as a marriage certificate or court order.
•
Enclose the public health nurse certificate.
Other, explain:
DOCUMENT REQUESTED
LPN License # _____________________. Include $20.00 nonrefundable fee.
RN License # ______________________. Include $ ...
Date:
June
16, 2019
... by Minnesota Statutes, Chapter 319B.11
Subdivision 4.
Print or Type ...
2. Provide the name, address and Minnesota License number for each owner of an ownership interest ...
Date:
May
17, 2023