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Get Nevada State Board Of Nursing

E 300, Reno, NV 89502-6547, (775) 687-7707 (fax) (888) 590-6726 (telephone) www.nursingboard.state.nv.us (NOTE: The address on this application will become your address of record unless you specify otherwise.) A change of name will be made upon receipt of this form; a copy of your marriage certificate, driver s license or other official court document. Designation License/Certificate # Designation RN LPN CNA License/Certificate # APN CRNA EMS/RN CNA INSTR New Name Former Name Social.

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