This document provides a license verification for Nicholas Mark Hazel. It summarizes that he holds an active LPN license in Oregon which will expire in November 2016, and previously held a CNA license that expired in 2014. No disciplinary actions are recorded against his licenses by the Oregon State Board of Nursing. Contact information is provided for inquiries about licensure status or disciplinary records.

1. 6/15/2015 OR License Verification
http://osbn.oregon.gov/OSBNVerification/Details.aspx?person=a4dea002­74dd­df11­af93­0021f6000008 1/1
Oregon State Board of Nursing
Verification of Licensure
SUBJECT TO TERMS AND CONDITIONS
Information current as of: 06/15/2015
Query Time: 6/15/2015 1:36:53 PM
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Licensee: Hazel, Nicholas Mark
Gender: Male
City: Eugene
County: Lane
State: OR
LICENSES
License Number Type License Issued Current Status Date Last Renewed License Expiration Date
201030262LPN LPN 07/30/2010 Active 09/11/2014 11/28/2016
200812760CNA CNA 12/11/2008 Expired 11/20/2012 11/28/2014
Click here for explanation of License Status
BOARD ORDERS
No disciplinary actions on record.
Click here for explanation of Disciplinary Actions
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* ­ An asterisk (*) after the Active status indicates that a licensee has applied for renewal on time but OSBN has not yet completely processed the
renewal application.
Call the OSBN at 971­673­0685 for licensure information.
OSBN Discipline ­ Copies of public documents associated with OSBN disciplinary actions taken against a specific licensee after August 2010 are available
online. Copies of disciplinary actions prior to that date may be obtained by written request. You may e­mail your request to osbn.records@state.or.us. Or, you
may FAX your request, addressed to Rebecca Nyberg, to 971­673­0684. Please include the licensee's name and license number (if available), along with your
name, company (if applicable), mailing address, phone number and FAX number or e­mail address.