ANDREA MARIE BLACK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****34

License Status

ACTIVE

Business

First Name

ANDREA

Middle

MARIE

Last Name

BLACK

Business Name

ANDREA MARIE BLACK

Original Issue Date

01/18/2012

Effective Date

02/11/2026

Expiration Date

03/01/2028

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/11/2026