SHOSHANA B CHURCH Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****92

License Status

ACTIVE

Business

First Name

SHOSHANA

Middle

Last Name

CHURCH

Business Name

SHOSHANA B CHURCH

Original Issue Date

11/06/2003

Effective Date

02/06/2026

Expiration Date

03/01/2028

City

CARTERVILLE

State

Zip

62918

County

WILLIAMSON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/06/2026