License holder summary

TAMARA LANAY PETTIS is a Board Of Medicine licensed to practice in Idaho. The address on file for TAMARA LANAY PETTIS is 636 SOUTH PIKE ST SHELBYVILLE IN 46176. This licensed professional license is not current. The license was granted 05/23/2006 and expired on 06/30/2007.

Idaho

Division of Occupational and Professional Licenses

TAMARA LANAY PETTIS
Board Of Medicine
License number
LRT-1164
Date granted
05/23/2006
Date expires
06/30/2007
Class
Board Of Medicine
Status
Canceled
Address
636 SOUTH PIKE ST SHELBYVILLE IN 46176
idaholicensing.com
ID 48371703
LAST UPDATED 2024-03-23 00:22:53 UTC

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