DARA M WAGNER Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****93

License Status

ACTIVE

Business

First Name

DARA

Middle

Last Name

WAGNER

Business Name

DARA M WAGNER

Original Issue Date

07/27/2020

Effective Date

03/06/2024

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