License holder summary

SUSAN RUTH PROVOW is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for SUSAN RUTH PROVOW is BOX 72A ROUTE #2, NEW CARLISLE IN, NEW CARLISLE IN 46552. This licensed professional license is not current. The license was granted 07/10/1978 and expired on 10/31/1983.

Indiana

Professional Licensing Agency

SUSAN RUTH PROVOW
Controlled Substance Registration - Physician
License number
01028452B
Date granted
07/10/1978
Date expires
10/31/1983
Class
Controlled Substance Registration - Physician
Status
Expired
Address
BOX 72A ROUTE #2, NEW CARLISLE IN, NEW CARLISLE IN 46552
indianalicensing.org
ID 5904222
LAST UPDATED 2024-04-30 14:04:49 UTC

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