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Louisiana State Board of Nursing

MAILING ADDRESS . Baton Rouge LA 70810 CITY STATE ZIP CODE . Provide/print the following information below: / / / APPLICANT’S FULL NAME (print) DATE OF BIRTH RACE SEX . SOCIAL SECURITY NUMBER . ALL INFORMATION RELEASED MUST REMAIN STRICTLY CONFIDENTIAL AND ONLY

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  Name, Address, Baton, Rouge, Baton rouge

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