SAMANTHA FREDRICKSON Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****42

License Status

INOPERATIVE

Business

First Name

SAMANTHA

Last Name

FREDRICKSON

Business Name

SAMANTHA FREDRICKSON

Original Issue Date

05/16/2025

Effective Date

05/16/2025

Expiration Date

03/01/2026

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

01/07/2026