SAMANTHA R WENNERBERG Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003989

License Status

NOT RENEWED

Business

First Name

SAMANTHA

Middle

Last Name

WENNERBERG

Business Name

SAMANTHA R WENNERBERG

Original Issue Date

02/08/2011

Effective Date

02/08/2011

Expiration Date

03/01/2012

City

LEMONT

State

Zip

60439

County

DUPAGE

Ever Disciplined

LastModifiedDate

11/23/2015