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  :  12/19/2011
Application#  :  410593
Name  :  NANCE, MARK DAVID
Profession  :  Respiratory Care Practitioner
Address  :  granbury, TX
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)
Wisconsin Statutes & Rules Examination Met
Application Fee Met
Pd 8/22/11 $160
PAGE 2 All activities & practice accounted for from date of graduation to present. Provide employers name, location (city&state), dates (month&year), # of hours worked per week, job title & duties Met
Applicable blanks completed Met
Verification of other state license(s) and/or credential(s) Met
Rec'd: CO, NM, OR, TX, WA, WV
PAGE 3 & 4 All questions answered and relevant copies attached Met
PAGE 5 Affidavit of applicant, signed and notarized Met
DOCUMENTS REQUIRED Social Security Number Collection Form (#2380) Met
Certificate of Professional Education (Form #1792) Met
Graduated 1/00
Practice of Respiratory Care (Form #1794) Met
Temporary Certificate Request for Certified Practitioners # 2871 (For Individuals licensed in another state) Met
Temp #4224
Valid 12/6/11
Expires 3/6/12
Verification of certification from the National Board for Respiratory Care, Inc. Met
Certification of Legal Status Completed Met