TRACI S WAGNER Nursing Home Administrator License verification

Business Entity

INACTIVE

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR

License Number

044005938

License Status

INACTIVE

Business

First Name

TRACI

Middle

Last Name

WAGNER

Business Name

TRACI S WAGNER

Original Issue Date

04/11/2001

Effective Date

12/01/2003

Expiration Date

11/30/2005

City

DIXON

State

Zip

61021

County

LEE

Ever Disciplined

LastModifiedDate

10/11/2005