Get Nm Duplicate Or Replacement Certificate Of Licensure Application Form 2020-2025

Filling out the NM Duplicate Or Replacement Certificate Of Licensure Application Form online is a straightforward process designed to help you obtain duplicate or replacement certificates for your medical imaging or radiation therapy license. This guide will provide clear steps to ensure you complete the application accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the application form and open it in the editor for electronic completion.
2. Begin by filling out Section 1 - General Information. Enter your MIRTP Registration Number, name, address, phone numbers, email address, and birth date accurately.
3. If you are requesting a replacement certificate, check the appropriate box in Section 2, confirming you meet the requirements for an additional license.
4. Proceed to Section 3 to provide information about any active credentialing organizations you are associated with. Fill in the ID numbers and credentials that apply to you.
5. In Section 4, review the fee schedule. Enter the amounts in the designated boxes based on how many duplicate or replacement certificates you are requesting.
6. Select your payment method in Section 5, indicating whether you are making an electronic payment or using a check or money order.
7. Complete Section 6 by checking all required acknowledgements. Ensure that all boxes are checked to confirm the completeness of your application.
8. In Section 7, provide your signature and date the form. Ensure your signature is valid for your application to be processed.
9. Once all sections are completed, save your changes. You can then download, print, or share the form as necessary, ensuring to submit it electronically or by mail as per your choice.

Complete your NM Duplicate Or Replacement Certificate Of Licensure Application Form online now for swift processing.