NICOLE I WAGNER Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****81

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

Last Name

WAGNER

Business Name

NICOLE I WAGNER

Original Issue Date

05/07/2019

Effective Date

05/07/2022

Expiration Date

06/30/2024

City

WAUKEGAN

State

Zip

60085

County

LAKE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025