GUSTEN C WALLACE Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043113520

License Status

NOT RENEWED

Business

First Name

GUSTEN

Middle

Last Name

WALLACE

Business Name

GUSTEN C WALLACE

Original Issue Date

09/26/2011

Effective Date

11/08/2012

Expiration Date

01/31/2015

City

GOLCONDA

State

Zip

62938

Ever Disciplined

LastModifiedDate

03/09/2015