DONNA M WALLACE APRN
Controlled Substance Registration for Practitioner


Address: 180 Regency Terrace, Stratford, CT 06615

DONNA M WALLACE APRN (Credential# 511904) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.

Business Overview

DONNA M WALLACE APRN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0044453. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 180 Regency Terrace, Stratford, CT 06615. The current status is active.

Basic Information

Licensee Name DONNA M WALLACE APRN
Credential ID 511904
Credential Number CSP.0044453
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 180 Regency Terrace
Stratford
CT 06615
Business Type INDIVIDUAL
Status ACTIVE - CURRENT
Active 1
Issue Date 2008-08-19
Effective Date 2019-03-01
Expiration Date 2021-02-28
Refresh Date 2019-01-22

Other licenses

ID Credential Code Credential Type Issue Term Status
575283 10.071277 Registered Nurse 2003-06-24 2019-09-01 - 2020-08-31 ACTIVE
682018 12.003840 Advanced Practice Registered Nurse 2008-08-04 2019-09-01 - 2020-08-31 ACTIVE

Office Location

Street Address 180 REGENCY TERRACE
City Stratford
State CT
Zip Code 06615

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Naomi M Ragsdale 180 Regency Terrace, Stratford, CT 06615 Licensed Clinical Social Worker 2017-11-01 ~ 2018-10-31

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James A Phillips 735 Broad Street, Stratford, CT 06615 Backflow Prevention Device Tester 2020-05-27 ~ 2023-03-31
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Competitor

Search similar business entities

City Stratford
Zip Code 06615
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + Stratford

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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