THOMAS J WAGNER Nursing Home Administrator License verification

Business Entity

NOT RENEWED

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR

License Number

044002775

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

Last Name

WAGNER

Business Name

THOMAS J WAGNER

Original Issue Date

07/07/1983

Effective Date

12/01/2007

Expiration Date

11/30/2009

City

OSHKOSH

State

Zip

54904

County

WISCONSIN

Ever Disciplined

LastModifiedDate

01/07/2010