BLAIR WAGNER - Nursing Home Administrator License in Illinois | # 045002710

BLAIR WAGNER

Business Entity

NOT RENEWED

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR TEMPORARY

License Number

045002710

License Status

NOT RENEWED

Business

N

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

State

IL

Ever Disciplined

N

LastModifiedDate

05/31/2005