License holder summary

Alysa M. Fog is a Controlled Substance Registration-Physician Assistant licensed to practice in Indiana. The address on file for Alysa M. Fog is Orthopaedics Northeast, P.C., 5050 N. Clinton Street, Fort Wayne IN 46825. This licensed professional license is not current. The license was granted 02/27/2009 and expired on 06/30/2012.

Indiana

Professional Licensing Agency

Alysa M. Fog
Controlled Substance Registration-Physician Assistant
License number
10000973B
Date granted
02/27/2009
Date expires
06/30/2012
Class
Controlled Substance Registration-Physician Assistant
Status
Expired
Address
Orthopaedics Northeast, P.C., 5050 N. Clinton Street, Fort Wayne IN 46825
indianalicensing.org
ID 8386442
LAST UPDATED 2024-03-21 22:17:36 UTC

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