BRIANA L RUSSOM Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****89

License Status

ACTIVE

Business

First Name

BRIANA

Middle

Last Name

RUSSOM

Business Name

BRIANA L RUSSOM

Original Issue Date

10/21/2010

Effective Date

01/20/2026

Expiration Date

03/01/2028

City

BYRON

State

Zip

61010

County

OGLE

Ever Disciplined

LastModifiedDate

01/20/2026