Russell Anthony Provenzo Jr
ExpiredCalifornia license 479638
License
- Licensed by
- California Board of Registered Nursing
- License number
- 479638
- Status
- Expired (Delinquent)
- First issued
- July 31, 1992
- Expired
- April 30, 2018
- License holder
- Russell Anthony Provenzo Jr
- Entity type
- Individual
Classifications
- Registered Nurse Nursing
More from the license record
- License type code
- 4001
Contact
12 Foster Ridge Dr
Hamburg, NY 14075-1805
Hamburg, NY 14075-1805
Erie County