DIANE KATHERINE SAMSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001315

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

KATHERINE

Last Name

SAMSON

Business Name

DIANE KATHERINE SAMSON

Original Issue Date

12/27/1999

Effective Date

03/01/2018

Expiration Date

03/01/2020

City

MORTON GROVE

State

Zip

60053

County

COOK

Ever Disciplined

LastModifiedDate

11/24/2020