CHARLESETTA M WALLACE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****91

License Status

ACTIVE

Business

First Name

CHARLESETTA

Middle

Last Name

WALLACE

Business Name

CHARLESETTA M WALLACE

Original Issue Date

12/10/2025

Effective Date

12/10/2025

Expiration Date

05/31/2026

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026