SAMANTHA K BLACK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005831

License Status

NOT RENEWED

Business

First Name

SAMANTHA

Middle

Last Name

BLACK

Business Name

SAMANTHA K BLACK

Original Issue Date

05/17/2016

Effective Date

02/12/2020

Expiration Date

03/01/2022

City

PARK RIDGE

State

Zip

60068

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2022