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Ve Practice is the last page in this form. Send the single page to the Alabama Board of Medical Examiners with payment of the Physician s Collaborative Practice annual fee ($100.00). The physician is required to have an unencumbered Alabama medical license. 8. The CRNP/CNM applicant is responsible for the truth and accuracy of the completed application. Print legibly in black ink or type the required information on this form. Illegible or incomplete applications will be returned along with t.

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