CREDENTIALS OF EMERGENCY DEPARTMENT PHYSICIANS
Identify completion of APLS, PALS or ENPC. Note the number of pediatric CME/CEU that have been completed within the past two years. Provider Name F=Full Time. P=Part. Time Date of Hire License Verification * NP = Illinois Advanced Practice License PA = Illinois License Exp. Date. Nurse Practitioner (Check one) Course Completion Exp. ................
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