License holder summary

LISA NAN BOOTH is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for LISA NAN BOOTH is 207 N. Townline Rd., Suite 104, Lagrange IN 46761. This licensed professional license is current. The license was granted 07/29/1993 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

LISA NAN BOOTH
Controlled Substance Registration - Physician
License number
01041550B
Date granted
07/29/1993
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
207 N. Townline Rd., Suite 104, Lagrange IN 46761
indianalicensing.org
ID 5881028
LAST UPDATED 2026-05-11 17:45:53 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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