License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.09892-NM Certified Nurse MidWife 01/29/2008 07/31/2009 08/31/2011 LAPSED
CTP.09892-EX1 Prescriptive Authority - Externship 12/02/2008 12/02/2008 12/02/2009 EXPIRED
RN.177037-1 Registered Nurse-1 Certificate of Authority 03/17/1982 07/28/2009 08/31/2011 LAPSED Examination
License and Registration Information (cont.)
CredentialSpecialty 1Certifying Org 1Certifying ExpDate 1Specialty 2Certifying Org 2Certifying ExpDate 2Specialty 3Certifying Org 3Certifying ExpDate 3
Effective February 1, 2011, the Board will require primary source verification for advanced practice nurse national recertification. For this to occur, an advanced practice nurse must request that their national certifying organization notify the Board directly of national recertification within thirty days of their recertification. The Board will no longer accept documentation of recertification directly from a COA holder.


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