THE MISSOURI NURSES
Approved Provider NameAddress of Approved ProviderCity State ZIPCertifies that:Participant First Name Last Name, Credentialshas received insert number contact hours for successfully completingTitle of ActivityDate: Insert date of activityMidwest MSD Provider Approval #: __________[Insert Name of Approved Provider] is approved as a provider of nursing continuing professional development by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.Authorized Signature (optional)Title (typically Primary Nurse Planner or a Nurse Planner) ................
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