R9-16-106. Name Change; Duplicate License

A. To request a name change on a midwifery license or a duplicate midwifery license, a midwife shall submit in writing to the Department: 1. The midwife’s name on the current midwifery license; 2. If applicable, the midwife’s new name; 3. The midwife’s address, license number, and e-mail address; 4. As applicable: a. Documentation supporting the midwife’s name change, or b. A statement that the midwife is requesting a duplicate midwifery license; and 5. A non-refundable fee of $10.00. B. Upon receipt of the written request required in subsection (A), the Department shall issue, as applicable: 1. An amended midwifery license that incorporates the name change but retains the expiration date of the midwifery license, or 2. A duplicate midwifery license.