SAMANTHA R WENNERBERG Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****70

License Status

NOT RENEWED

Business

First Name

SAMANTHA

Middle

Last Name

WENNERBERG

Business Name

SAMANTHA R WENNERBERG

Original Issue Date

02/16/2011

Effective Date

02/16/2011

Expiration Date

03/01/2012

City

PEORIA

State

Zip

61606

County

PEORIA

Ever Disciplined

LastModifiedDate

11/23/2015