MARY MARGARET STAUB Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****00

License Status

NOT RENEWED

Business

First Name

MARY

Middle

MARGARET

Last Name

STAUB

Business Name

MARY MARGARET STAUB

Original Issue Date

05/20/2014

Effective Date

01/05/2022

Expiration Date

03/01/2024

City

URBANA

State

Zip

61802

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025