Indiana
Professional Licensing Agency
Traci L. Derda
Radiology Provisional Permit
License number
XP503271
Date granted
03/21/2011
Date expires
09/21/2011
Class
Radiology Provisional Permit
Status
Expired Non-Renewable
Address
Granger IN 46530-8147
indianalicensing.org
ID 8491432
LAST UPDATED 2026-05-19 05:34:39 UTC
LAST UPDATED 2026-05-19 05:34:39 UTC
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