Alysa M. Fog
Temporary Physician Assistant Permit
Indiana 99030636A Superceded
This Indiana license was held by Alysa M. Fog. The license is no longer active. It was granted on 01/18/2008 and expired on 10/18/2008
LICENSE DETAILS
- License Number: 99030636A
- Category: Temporary PA Permit
- Status: Superceded
- Date Granted: 01/18/2008 (over 16 years ago)
- Expiry Date: 10/18/2008 (over 15 years ago)
LOCATIONS
A Address
Fort Wayne IN 46825