KELLY NICOLE WALLACE Respiratory Care Practitioner License verification

Business Entity

NOT RENEWED

License Type

Respiratory Care Practitioner

Description

RESPIRATORY CARE PRACTITIONER

License Number

194004763

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

NICOLE

Last Name

WALLACE

Business Name

KELLY NICOLE WALLACE

Original Issue Date

08/16/2001

Effective Date

11/12/2003

Expiration Date

10/31/2005

City

CHICAGO

State

Zip

60628

County

COOK

Ever Disciplined

LastModifiedDate

12/22/2005