Indiana
Professional Licensing Agency
Tricia G. Fullmer
Radiology Provisional Permit
License number
XP502068
Date granted
10/20/2009
Date expires
04/20/2010
Class
Radiology Provisional Permit
Status
Expired Non-Renewable
Address
North Liberty IN 46554-9004
indianalicensing.org
ID 8494516
LAST UPDATED 2026-06-16 15:46:52 UTC
LAST UPDATED 2026-06-16 15:46:52 UTC
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