Application Status Query

Instructions: 

Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.

Please verify the checklist information below, including your address. If your address has changed, please e-mail your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.

As of  :  07/24/2006
Application#  :  252236
Name  :  SALZMAN, NITA H
Profession  :  Medicine and Surgery, MD
Address  :  MEQUON, WI
Application Status  :  (Permanent license issued)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
WI Statute & Rules Examination Met
Passed
Application Fee Met
Pd. $110.00 5/8/06 $
Pages One and Two - Applicable blanks completed Met
Pre-Professional and Professional Education Met
All activities and practice accounted for Met
Pages Three, Four and Five - Applicable blanks completed Met
Affidavit of applicant, signed Met
National Board Scores, original certification Met
Authorization and Waiver, signed (Form #571) Met
Copy of Medical diploma Met
Physicians Profile Data Report from AOA or AMA Met
Physician Data Center Practitioner Profile Report (Form #1445) Met
Work History (Form #1934) Met
Medical Education Verification Form (Form #2164) Met
Certificate of Post-Graduate Training (Form #2165) Met
Received Hospital, Facility and Employer Verification Forms Met
Hospital, Facility, and Employer Verification (Form #2167) Met
See letter in file - ok
Verification of state license(s) directly from State Board office(s) Met
PA
National Practitioner Data Bank Report/Self-query response Met
Social Security Number Met
Oral Exam to be determined after application is completed Met
Oral interview/exam required - next available dates: 7/19, 8/16, 9/20 - more information will be mailed.