License holder summary

MS. STEPHANIE LYNN FAGAN is a Board Of Medicine licensed to practice in Idaho. The address on file for MS. STEPHANIE LYNN FAGAN is 1516 BIRNAM DR CHARLOTTESVILLE VA 22901. This licensed professional license is not current. The license was granted 04/06/2012 and expired on 08/01/2014.

Idaho

Division of Occupational and Professional Licenses

MS. STEPHANIE LYNN FAGAN
Board Of Medicine
License number
LRT-1610
Date granted
04/06/2012
Date expires
08/01/2014
Class
Board Of Medicine
Status
Canceled
Address
1516 BIRNAM DR CHARLOTTESVILLE VA 22901
idaholicensing.com
ID 48334301
LAST UPDATED 2024-03-15 17:29:37 UTC

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