SAMANTHA NICHOLE LAYSTROM Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****16

License Status

ACTIVE

Business

First Name

SAMANTHA

Middle

NICHOLE

Last Name

LAYSTROM

Business Name

SAMANTHA NICHOLE LAYSTROM

Original Issue Date

06/26/2021

Effective Date

01/20/2026

Expiration Date

03/01/2028

City

GRAYSLAKE

State

Zip

60030

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/20/2026