SAMANTHA KAY KOZAK LIEM Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****61

License Status

ACTIVE

Business

First Name

SAMANTHA

Middle

KAY KOZAK

Last Name

LIEM

Business Name

SAMANTHA KAY KOZAK LIEM

Original Issue Date

08/02/2018

Effective Date

05/30/2024

Expiration Date

05/31/2026

City

MAYWOOD

State

Zip

60153

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026