Professional Documents
Culture Documents
1. Complete your name and mailing address in areas marked and forward the form to the State Board where currently licensed.
2. In addition to filing the original of this form, please submit:
a) Appropriate fee.
The above applicant has applied for license to practice nursing in the Commonwealth of the Northern Mariana Islands. Please supply the following information
and return this form directly to:
To be completed by licensing board and sent to Commonwealth Board of Nurse Examiners listed above.
License Number: Issue Date: Expiration Date: How issued?