SAMANTHA R KAUCHAK Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****07

License Status

ACTIVE

Business

First Name

SAMANTHA

Middle

Last Name

KAUCHAK

Business Name

SAMANTHA R KAUCHAK

Original Issue Date

02/08/2023

Effective Date

03/20/2024

Expiration Date

05/31/2026

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026