SAMANTHA K BLACK - Physician Assistant License in Illinois | # 085005831

SAMANTHA K BLACK

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005831

License Status

NOT RENEWED

Business

N

First Name

SAMANTHA

Middle

K

Last Name

BLACK

Business Name

SAMANTHA K BLACK

Original Issue Date

05/17/2016

Effective Date

02/12/2020

Expiration Date

03/01/2022

State

IL

Ever Disciplined

N

LastModifiedDate

07/27/2022