JENNIFER K WALLACE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****31

License Status

ACTIVE

Business

First Name

JENNIFER

Middle

Last Name

WALLACE

Business Name

JENNIFER K WALLACE

Original Issue Date

06/26/2025

Effective Date

06/26/2025

Expiration Date

05/31/2026

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026