ADAM L WALLER Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****08

License Status

ACTIVE

Business

First Name

ADAM

Middle

Last Name

WALLER

Business Name

ADAM L WALLER

Original Issue Date

09/03/2020

Effective Date

05/02/2024

Expiration Date

05/31/2026

City

WEST FRANKFORT

State

Zip

62896

County

FRANKLIN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026