SAMANTHA SAMARYCZEW Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****30

License Status

ACTIVE

Business

First Name

SAMANTHA

Last Name

SAMARYCZEW

Business Name

SAMANTHA SAMARYCZEW

Original Issue Date

10/15/2025

Effective Date

03/01/2026

Expiration Date

03/01/2028

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

03/01/2026