AMANDA L WALLACE Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043088849

License Status

NOT RENEWED

Business

First Name

AMANDA

Middle

Last Name

WALLACE

Business Name

AMANDA L WALLACE

Original Issue Date

09/08/2003

Effective Date

11/08/2012

Expiration Date

01/31/2015

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Ever Disciplined

LastModifiedDate

03/09/2015