Indiana
Professional Licensing Agency
Joy Anne DeRusha
Controlled Substance Registration-Physician Assistant
License number
10000869B
Date granted
10/18/2011
Date expires
06/30/2014
Class
Controlled Substance Registration-Physician Assistant
Status
Expired
Address
5815 Calumet, Hammond IN 46320
indianalicensing.org
ID 8386900
LAST UPDATED 2024-05-02 12:25:05 UTC
LAST UPDATED 2024-05-02 12:25:05 UTC
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