Indiana
Professional Licensing Agency
Mary VanKooten
Controlled Substance Registration - Physician
License number
01057928B
Date granted
08/27/2004
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
421 S. Landmark Avenue, Bloomington IN 47403
indianalicensing.org
ID 5825258
LAST UPDATED 2026-04-19 23:00:46 UTC
LAST UPDATED 2026-04-19 23:00:46 UTC
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