CAROLYN WAGNER Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****23

License Status

NOT RENEWED

Business

First Name

CAROLYN

Last Name

WAGNER

Business Name

CAROLYN WAGNER

Original Issue Date

06/26/2001

Effective Date

03/13/2018

Expiration Date

09/30/2020

City

FORSYTH

State

Zip

62535

County

MACON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021