JILL LOUISE WAGENBACH Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****83

License Status

ACTIVE

Business

First Name

JILL

Middle

LOUISE

Last Name

WAGENBACH

Business Name

JILL LOUISE WAGENBACH

BusinessDBA

JILL WAGENBACH

Original Issue Date

10/07/2024

Effective Date

10/07/2024

Expiration Date

05/31/2026

City

PEORIA

State

Zip

61614

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026