HEATHER LYNN SAMUDOVSKY Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****26

License Status

ACTIVE

Business

First Name

HEATHER

Middle

LYNN

Last Name

SAMUDOVSKY

Business Name

HEATHER LYNN SAMUDOVSKY

Original Issue Date

12/31/2020

Effective Date

02/24/2026

Expiration Date

03/01/2028

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/24/2026