SAMANTHA N PETTY Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****57

License Status

ACTIVE

Business

First Name

SAMANTHA

Middle

Last Name

PETTY

Business Name

SAMANTHA N PETTY

Original Issue Date

03/27/2023

Effective Date

03/18/2026

Expiration Date

05/31/2028

City

DIXON

State

Zip

61021

County

LEE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/18/2026