DIANE KATHERINE SAMSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****68

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

KATHERINE

Last Name

SAMSON

Business Name

DIANE KATHERINE SAMSON

Original Issue Date

03/13/2001

Effective Date

03/01/2018

Expiration Date

03/01/2020

City

WAUKEGAN

State

Zip

60085

County

LAKE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020