SUSAN L WALLER Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043035559

License Status

NOT RENEWED

Business

First Name

SUSAN L

Last Name

WALLER

Business Name

SUSAN L WALLER

Original Issue Date

09/11/1974

Expiration Date

05/01/1982

City

MAHOMET

State

Zip

61853

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

10/21/2005