DIANE LYNN JORDAN-WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036106006

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

LYNN

Last Name

JORDAN-WAGNER

Suffix

Business Name

DIANE LYNN JORDAN-WAGNER MD

Original Issue Date

12/19/2001

Effective Date

03/27/2020

Expiration Date

09/30/2020

City

PARIS

State

Zip

61944

County

EDGAR

Ever Disciplined

LastModifiedDate

01/14/2021