Idaho
Division of Occupational and Professional Licenses
MICHELLE LYLA WAGNER
Board Of Medicine
License number
PAT-767
Date granted
09/24/2009
Date expires
08/05/2011
Class
Board Of Medicine
Status
Expired
Address
627 W PINE AVE MERIDIAN ID 83642
idaholicensing.com
ID 48334534
LAST UPDATED 2024-04-10 19:07:55 UTC
LAST UPDATED 2024-04-10 19:07:55 UTC
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