Copy of nursing license pa
[PDF File]Requirements for Provider Type 05 – Home Health Agency
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051 – Private Duty Nursing 250 – DME/Medical Supplies 361 – Personal Care Agency ... Copy of license issued by the Department of Health (or applicable state licensing agency if Provider is Out-of-State), authorizing Provider ... Copy of Corporation papers issued by the Department of State Corporation Bureau or a copy of the business ...
[PDF File]APPLICATION FOR LICENSE
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APPLICATION FOR LICENSE (AGL 02) 1. NAME, ADDRESS AND PHONE NUMBER OF PHYSICAL SITE OF FACILITY: Indicate name, address and phone number of physical facility where the services will be provided. If the application is for renewal, the name and address of the facility should be the same as on previous application unless name is changed. 2.
[PDF File]RN/LPN REINSTATEMENT
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If you hold a RN/LPN license is a state that does not participate in Nursys Licensure Verification or you have non-nursing licenses, print an official verification from that state’s licensing website. If you have had any disciplinary action(s) taken against a health-care related license in another state, you must submit a copy of
[PDF File]Requirements for Provider Type 09 - Certified Registered ...
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Copy of your DEA certificate, if applicable If the Provider is not a citizen of the United States, submit copy of Permanent Resident Card or Form I-797 showing proof of authorization to work in the United States Copy of current license issued by Department of State
[PDF File]Duplicate License Form - New Jersey Division of Consumer ...
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New Jersey Board of Nursing 124 Halsey Street, 6th Floor, P.O. Box 45010. Newark, New Jersey 07101 ... This is to verify that my license/certification to practice as a nurse/CHHA for the current renewal cycle has never . ... be used as your public address of record, your mailing address will be considered your address of record. *A Post Office Box
[PDF File]Frequently Asked Questions Act 31 Child Abuse Recognition ...
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Frequently Asked Questions Act 31 – Child Abuse Recognition and Reporting Requirements 1. What is Act 31 and who is required to comply with the new law? Act 31 of 2014 states that the Bureau of Professional and Occupational Affairs (BPOA), in conjunction with the
[PDF File]2016, Act 407, Eff. Apr. 4, 2017.
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(i) "Public access" means the right of a person to view and copy files under the freedom of information act, 1976 PA 442, MCL 15.231 to 15.246. (j) "Rule" means a rule promulgated under the administrative procedures act of 1969.
[PDF File]Home Health Agency Change of Ownership or Control
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Completed “Information Requested of Health Care Providers Applying for a License” form. Proof of tax ID number (IRS SS-4 form). Copy of PA Dept. of State business name registration confirmation. Copy of PA Dept. of State fictitious name registration confirmation, if applicable. Résumé and criminal history clearance for owner(s).
[PDF File]Online Instructions for GRADUATES Applying for Exam and/or ...
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- Select State Board of Nursing • License Type ... along with a copy of an evaluation completed by a licensed physician, psychologist, certified registered nurse practitioner, physician assistant, optometrist, ophthalmologist or audiologist dated within the last 5 years from the date of theapplication.
[PDF File]Commonwealth of Pennsylvania Department of Health ...
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The regular fee per license is $500. Mail the completed and signed original application materials and check or money order to: Pennsylvania Department of Health Division of Home Health 555 Walnut Street, 7th Floor, Suite 701 Harrisburg, PA 17101. IMPORTANT: Please retain a copy …
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