SUSAN M DIBBLEE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****31

License Status

NOT RENEWED

Business

First Name

SUSAN

Middle

Last Name

DIBBLEE

Business Name

SUSAN M DIBBLEE

Original Issue Date

01/08/2004

Effective Date

01/11/2022

Expiration Date

03/01/2024

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

02/05/2025