Indiana
Professional Licensing Agency
Melanie L. Pequignot
Controlled Substance Registration-Physician Assistant
License number
10001156B
Date granted
01/28/2011
Date expires
06/30/2016
Class
Controlled Substance Registration-Physician Assistant
Status
Active
Address
2518 E Dupont Road, Fort Wayne IN 46825
indianalicensing.org
ID 8386602
LAST UPDATED 2024-04-17 01:23:58 UTC
LAST UPDATED 2024-04-17 01:23:58 UTC
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