LORI S G VERSEMAN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****02

License Status

NOT RENEWED

Business

First Name

LORI

Middle

S G

Last Name

VERSEMAN

Business Name

LORI S G VERSEMAN

Original Issue Date

12/29/2006

Effective Date

02/12/2022

Expiration Date

03/01/2024

City

GALESBURG

State

Zip

61401

County

KNOX

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025