GRACE ELIZABETH WAGNER Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****34

License Status

ACTIVE

Business

First Name

GRACE

Middle

ELIZABETH

Last Name

WAGNER

Business Name

GRACE ELIZABETH WAGNER

Original Issue Date

08/31/2021

Effective Date

03/12/2026

Expiration Date

05/31/2028

City

PEORIA

State

Zip

61615

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/12/2026