Indiana
Professional Licensing Agency
Stephen Christopher Provenza
Controlled Substance Registration-Physician Assistant
License number
10001076B
Date granted
03/27/2009
Date expires
06/30/2010
Class
Controlled Substance Registration-Physician Assistant
Status
Expired
Address
Foundations Family Medicine, 905 W Keegan's Way, Greensburg IN 47240
indianalicensing.org
ID 8386823
LAST UPDATED 2024-04-14 03:28:45 UTC
LAST UPDATED 2024-04-14 03:28:45 UTC
This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.