JODI LORENE BANGERT Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****80

License Status

ACTIVE

Business

First Name

JODI

Middle

LORENE

Last Name

BANGERT

Business Name

JODI LORENE BANGERT

Original Issue Date

11/28/2011

Effective Date

12/11/2023

Expiration Date

03/01/2026

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025