Indiana
Professional Licensing Agency
Autumn A. Jackson
Controlled Substance Registration-Physician Assistant
License number
10001069B
Date granted
02/27/2009
Date expires
06/30/2012
Class
Controlled Substance Registration-Physician Assistant
Status
Expired
Address
Clarian West, 1111 N Ronald Reagan Parkway, Avon IN 46123
indianalicensing.org
ID 8385730
LAST UPDATED 2024-05-10 16:55:04 UTC
LAST UPDATED 2024-05-10 16:55:04 UTC
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