NATHASA N WALLACE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****79

License Status

ACTIVE

Business

First Name

NATHASA

Middle

Last Name

WALLACE

Business Name

NATHASA N WALLACE

Original Issue Date

07/08/2015

Effective Date

05/02/2024

Expiration Date

05/31/2026

City

CHICAGO

State

Zip

60652

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026