The holder whose full name is Harley, Lisa Tamara,come from Fort Wayne IN,hold the Physician Assistant - Prescriptive Authority license(NO.10001309A) which status is Expired.
| Name | Harley, Lisa Tamara |
|---|---|
| License Number | 10001309A |
| License Type | Physician Assistant - Prescriptive Authority |
| License Status | Expired |
| City | Fort Wayne |
| State | IN |