License holder summary

Shaina M Brock is a Radiology Provisional Permit licensed to practice in Indiana. The address on file for Shaina M Brock is Peru IN 46970. This licensed professional license is current. The license was granted 07/09/2014 and expired on 01/09/2015.

Indiana

Professional Licensing Agency

Shaina M Brock
Radiology Provisional Permit
License number
XP505661
Date granted
07/09/2014
Date expires
01/09/2015
Class
Radiology Provisional Permit
Status
Active
Address
Peru IN 46970
indianalicensing.org
ID 29207423
LAST UPDATED 2024-04-03 19:35:42 UTC

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