CHARLESETTA M WALLACE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADVANCED PRACTICE REGISTERED NURSE

License Number

209033647

License Status

ACTIVE

Business

First Name

CHARLESETTA

Middle

Last Name

WALLACE

Business Name

CHARLESETTA M WALLACE

Original Issue Date

10/23/2025

Effective Date

10/23/2025

Expiration Date

05/31/2026

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

03/02/2026