WALLACE ADAM GOFORTH - Advanced Practice Nurse License in Illinois | # 209016165

WALLACE ADAM GOFORTH

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADVANCED PRACTICE REGISTERED NURSE

License Number

209016165

License Status

NOT RENEWED

Business

N

First Name

WALLACE

Middle

ADAM

Last Name

GOFORTH

Business Name

WALLACE ADAM GOFORTH

Original Issue Date

07/12/2017

Effective Date

04/26/2018

Expiration Date

09/30/2020

State

IL

Ever Disciplined

N

LastModifiedDate

01/14/2021