SAMANTHA K BLACK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****20

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

04/22/2020

Expiration Date

03/01/2022

City

CHICAGO

State

Zip

60637

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022