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Indiana Professional Licensing Agency

PLA > Professions > Indiana State Board of Nursing > Nursing Licensure: Applications, Instructions, & Verification > Name and Address Change Instructions Name and Address Change Instructions

Name changes
If a change of name is requested, licensee shall submit a copy of a marriage certificate or court order. Copies of Social Security cards are not acceptable. Licensees may maintain the legal name of preference. Please mail your document(s) with a cover page indicating the following: license number, name currently on your license record, indication of how you would like your name to display on your record.

Address changes
If you have had a change in your home address, e-mail and/or phone number you may log onto your record 24/7 on our
website to make these updates. Log in is your primary license number (RN’s will use their RN number including the letter A and LPN’s will use their LPN number including the letter A) Password is always the last four digits of your Social Security number.