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------------------------- PROFESSIONAL LICENSE VERIFICATION ---------------------
Name...................: SAMPLE REPORT
Social Security #......: 444-44-4444
_________________________________________________________________________
_______________________STATE OF NY - Lic Practical Nurse_____________________
License#...............: 1234567
Origination Date.......: NONE PROVIDED
Expiration Date...,....: 10/31/99
Status.................: CURRENT / ACTIVE
Disciplinary Actions...: NONE PROVIDED
Verified by...........: NY BOARD OF NURSING
Title..................: AUTOMATED SYSTEM
Phone..................: (555) 555-5555
Entered by ............: KSS
Date...................: 04/06/01
Confirmed by...........: NAME AND LICENSE NUMBER #1234567
Comments...............: LAPSED LICENSED PRACTICAL NURSE
LICENSE WHICH EXPIRED 10/31/94
--- End of Report ---
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