Address Change

West Virginia Board of Examiners
for Registered Professional Nurses
101 Dee Drive, Suite 102
Charleston, WV 25311-1620
Phone: (304) 558-3596
Fax: (304) 558-3666
Email: rnboard@wv.gov

Address Change Form:
(printable)

License #		Soc.Sec. #
Name
New Address		Old Address

Phone Number: _____________________________________________ Email address: ______________________________________________

There is no charge for an address change, but it must be submitted in writing to the board office within thirty (30) days of the change.

REV:5/06

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