CAITLYN WAGENBACH Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****24

License Status

ACTIVE

Business

First Name

CAITLYN

Last Name

WAGENBACH

Business Name

CAITLYN WAGENBACH

Original Issue Date

03/22/2022

Effective Date

01/22/2026

Expiration Date

03/01/2028

City

PEORIA

State

Zip

61616

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/22/2026