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OFFICE OF PROFESSIONAL LICENSURE AND CERTIFICATION STATE OF NEW HAMPSHIRE PETER DANLES Executive Director DIVISION OF HEALTH PROFESSIONS 121 South Fruit Street Suite 303 Concord N.H. 03301-2412 Telephone 603-254-9261 Fax 603-279-8770 JOSEPH SHOEMAKER Division Director APPLICATION FORM FOR RECERTIFICATION AFTER LAPSE OF THE CERTIFICATE TO PRACTICE MIDWIFERY I. Personal Information Name of Midwife Home Address Home Phone Business Address Business Phone Email II. License Information License...
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