License holder summary

DANIELLE RENEE RUSSO is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for DANIELLE RENEE RUSSO is Wakarusa Medical Clinic, 207 North Elkhart P O Box 446, Wakarusa IN 46573. This licensed professional license is current. The license was granted 05/10/2003 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

DANIELLE RENEE RUSSO
Controlled Substance Registration - Physician
License number
01057584B
Date granted
05/10/2003
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Wakarusa Medical Clinic, 207 North Elkhart P O Box 446, Wakarusa IN 46573
indianalicensing.org
ID 5932098
LAST UPDATED 2024-01-26 05:56:10 UTC

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