DIVINE P. MENGUE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****48

License Status

ACTIVE

Business

First Name

DIVINE

Middle

Last Name

MENGUE

Business Name

DIVINE P. MENGUE

Original Issue Date

09/09/2025

Effective Date

02/06/2026

Expiration Date

03/01/2028

City

ORLAND PARK

State

Zip

60467

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/06/2026