ROBERT ERIC WALLACE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****59

License Status

ACTIVE

Business

First Name

ROBERT

Middle

ERIC

Last Name

WALLACE

Business Name

ROBERT ERIC WALLACE

Original Issue Date

10/26/2004

Effective Date

03/13/2026

Expiration Date

05/31/2028

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/13/2026