License holder summary

THERESE MARIE WILSON is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for THERESE MARIE WILSON is DERMATOLOGY & MAXILLOFACIAL SURGERY, 1201 MICHIGAN AVE SUITE 240, LOGANSPORT IN 46947. This licensed professional license is not current. The license was granted 05/09/1995 and expired on 06/30/1999.

Indiana

Professional Licensing Agency

THERESE MARIE WILSON
Controlled Substance Registration - Physician
License number
01043399B
Date granted
05/09/1995
Date expires
06/30/1999
Class
Controlled Substance Registration - Physician
Status
Expired
Address
DERMATOLOGY & MAXILLOFACIAL SURGERY, 1201 MICHIGAN AVE SUITE 240, LOGANSPORT IN 46947
indianalicensing.org
ID 5885905
LAST UPDATED 2024-04-13 05:42:34 UTC

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