BENJAMIN C WAGNER Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043104593

License Status

NOT RENEWED

Business

First Name

BENJAMIN

Middle

Last Name

WAGNER

Business Name

BENJAMIN C WAGNER

Original Issue Date

10/17/2007

Effective Date

01/30/2013

Expiration Date

01/31/2015

City

LEAF RIVER

State

Zip

61047

County

OGLE

Ever Disciplined

LastModifiedDate

03/09/2015