MS. STEPHANIE LYNN FAGAN
Idaho LRT-1610 Canceled
This Idaho license was held by MS. STEPHANIE LYNN FAGAN. The license is no longer active. It was granted on 04/06/2012 and expired on 08/01/2014
LICENSE DETAILS
- License Number: LRT-1610
- Category: Board Of Medicine
- Status: Canceled
- Date Granted: 04/06/2012 (about 13 years ago)
- Expiry Date: 08/01/2014 (almost 11 years ago)
LOCATIONS
A Residential
1516 BIRNAM DR CHARLOTTESVILLE VA 22901