Indiana
Professional Licensing Agency
Tina L. Fuller
Radiology Provisional Permit
License number
XP501312
Date granted
08/28/2008
Date expires
02/28/2009
Class
Radiology Provisional Permit
Status
Expired Non-Renewable
Address
Merrillville IN 46410
indianalicensing.org
ID 8493692
LAST UPDATED 2026-05-18 09:36:02 UTC
LAST UPDATED 2026-05-18 09:36:02 UTC
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