BLAIR WAGNER Nursing Home Administrator License verification

Business Entity

NOT RENEWED

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR TEMPORARY

License Number

045002710

License Status

NOT RENEWED

Business

First Name

BLAIR

Last Name

WAGNER

Business Name

BLAIR WAGNER

Original Issue Date

08/09/2000

Effective Date

10/25/2001

Expiration Date

05/12/2001

City

DECATUR

State

Zip

62521

County

MACON

Ever Disciplined

LastModifiedDate

05/31/2005