SAMANTHA ELIZABETH WAGNER Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****15

License Status

ACTIVE

Business

First Name

SAMANTHA

Middle

ELIZABETH

Last Name

WAGNER

Business Name

SAMANTHA ELIZABETH WAGNER

Original Issue Date

02/21/2019

Effective Date

03/12/2024

Expiration Date

05/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026