VERIFICATION TO A NON-NURSING BOARD

If you wish to have our office complete a licensure biography or verification for a non-nursing board (such as Medical Board, US Public Health Service, Massage Therapy Board, etc.) submit the form by fax (919-781-9461) or mail (P.O. Box 2129, Raleigh NC 27602).  If no form is available, you may submit a request that includes the following:

• Name and address
• NC nursing license number or social security number
• Name and address of facility requesting verification
• Specific information requested

 Be sure to indicate if the completed form is to be mailed to you or to the non-nursing board.

 Your signature authorizing release of this information is required on all requests.