MALLORY RENEE WALTRIP Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****42

License Status

ACTIVE

Business

First Name

MALLORY

Middle

RENEE

Last Name

WALTRIP

Business Name

MALLORY RENEE WALTRIP

Original Issue Date

03/14/2017

Effective Date

03/26/2026

Expiration Date

05/31/2028

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/26/2026