MANUEL WALLACE IV Registered Nurse License verification

Business Entity

NOT RENEWED

License Type

Registered Nurse

Description

LICENSED PRACTICAL NURSE

License Number

043120060

License Status

NOT RENEWED

Business

First Name

MANUEL

Last Name

WALLACE IV

Business Name

MANUEL WALLACE IV

Original Issue Date

12/05/2014

Effective Date

01/11/2017

Expiration Date

01/31/2019

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

03/28/2019