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Personal Information
Please enter information exactly as you would like it to appear in your list. For example if you enter T. as your middle name it will display that way. An example would be Robert T. Smithing.
Bold, red items are required. Unbold, green items are requested.
Name:       First, middle and last names. Please include a period (.) after a first or middle initial.
Credentials: These will follow your name in directory. Please do not use punctuation. Suggested format is Highest degree then licensure then other. Example: MSN ARNP FAAN. This field has 15 characters allowed.
Nick Name: If you like to use a nick name you can include it here. It will display with your formal name on directory listings. For example: Robert T. Smithing, MSN ARNP "Bob"
Year graduated: Year of graduation from NP, CNM or CRNA program. Use 4 digit year (2000).
Type of NP program:
Highest earned degree:
Gender:
Certified Specialty:
Certifying Body:
Practice Information (This information will be available for viewing on the web)
Please enter information about your desired position exactly as you would like it to appear in your listing.
Bold, red items are required. Unbold, green items are requested.
Position you are seeking: Enter the type of position you desire.
City / State / Zip:           
County / Country:     
Willing to relocate?
Specialty:    Select the predominant choices for your practice or submit a new specialty for consideration.
New Specialty:
Email:   
 Required so directory administrator can reach you. Not required to allow any other use.
Resume URL: On-line address of your resume web site.
 
Picture URL:
OR
 If you have a web address for a picture of you put it here. This should be a link directly to the picture itself.
Professional Status Information
The information below will not be released to employers. It will be used to try to identify and correct duplicate entries, to resolve other administrative issues and selectively for research.

E-mail your resume to resumes@nurse.net to be attached to your listing

Bold, red items are required. Unbold, green items are requested.
Practice Status:  
Prior Name:  
Date of Birth:  
Can you prescribe medications:  
Mail Preferences: No restrictions at this time
Do not send Employment information
Do not send NP organization information
Do not send Product information
Do not send Legislative information
Don't send any information		 Select as many choices as appropriate.
Contact Information
The information below will be released to employers.
Bold, red items are required. Unbold, green items are requested.
Home Address:  
City/State/Zip:        
Country:  
Phone / Fax:     
User Name and Password
Enter a User Name and Password so that you can come back and update your information at anytime.
User Name:  Password: 
Credit Card Information
To complete your listing, your credit card information is required.
Amount to charge: $25.00
Bold, red items are required. Unbold, green items are requested.
Type of Credit Card:
Name on Credit Card:
Credit Card Number:
Enter your card number without spaces.
Expiration Date: /
    
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