SHANNON D WALLER Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****95

License Status

ACTIVE

Business

First Name

SHANNON

Middle

Last Name

WALLER

Business Name

SHANNON D WALLER

Original Issue Date

12/09/2021

Effective Date

05/24/2024

Expiration Date

05/31/2026

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026