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NRP Instructor Registration Form 

 

NOTE: Before materials can be given out, we must receive 3 items:

 

1. Copy of current NRP Provider Card
2. Evidence of current training and experience in the hospital care of newborns in a delivery room, newborn, or critical care nursery setting.
3. Payment for the course (call 336-716-2800 if paying by credit card)

 
Last Name  
First Name  
Middle Initial  
Employee ID
(Required if NCBH or School Employee)
 
Credentials (MD, RN, etc)  
Address  
City  
State  
Zip Code  
Phone Number  
Place of Employment  
E-Mail Address  
Comments/Concerns    
   
We will notify you of your acceptance as an instructor candidate through the email address you provided.
 

 

 

 

Quick Reference

Life Support Education
Kathy Nelson
Manager

Phone 336-716-2005
Fax 336-716-5927

Contact Kathy
knelson@wakehealth.edu

Mikell White

Phone 336-716-2800
Fax 336-716-5927

Contact Mikell
miwhite@wakehealth.edu

 

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