The holder whose full name is Koger Gustafson, Desiree Dawn,come from Fort Wayne IN,hold the Health Facility Administrator license(NO.14004535A) which status is Inactive.
| Name | Koger Gustafson, Desiree Dawn |
|---|---|
| License Number | 14004535A |
| License Type | Health Facility Administrator |
| License Status | Inactive |
| City | Fort Wayne |
| State | IN |