MICHAEL C WAGNER II Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****61

License Status

INACTIVE

Business

First Name

MICHAEL

Middle

Last Name

WAGNER

Suffix

Business Name

MICHAEL C WAGNER II

Original Issue Date

09/20/2001

Effective Date

03/13/2018

Expiration Date

09/30/2020

City

DANVILLE

State

Zip

61832

County

VERMILION

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/12/2018