License holder summary

Jennifer N. Wallace is a Radiology Provisional Permit licensed to practice in Indiana. The address on file for Jennifer N. Wallace is Indianapolis IN 462372012. This licensed professional license is not current. The license was granted 06/09/2006 and expired on 12/31/2007.

Indiana

Professional Licensing Agency

Jennifer N. Wallace
Radiology Provisional Permit
License number
XP500264
Date granted
06/09/2006
Date expires
12/31/2007
Class
Radiology Provisional Permit
Status
Expired Non-Renewable
Address
Indianapolis IN 462372012
indianalicensing.org
ID 8492368
LAST UPDATED 2024-02-28 23:33:33 UTC

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