NameOPAL D FERGUSON
City/State

License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
DT.01808- Ohio Certified Dialysis Technician 10/22/2004 02/20/2015 03/31/2017 ACTIVE
TC1.01808- Temporary Dialysis Certificate 1 08/20/2003 08/20/2003 12/16/2004 EXPIRED

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