DANE C WALLACE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****86

License Status

ACTIVE

Business

First Name

DANE

Middle

Last Name

WALLACE

Business Name

DANE C WALLACE

Original Issue Date

08/29/2022

Effective Date

04/05/2024

Expiration Date

05/31/2026

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026