The holder whose full name is Blackford, Dianne E.,come from Elwood IN,hold the Preceptor Eligible license(NO.15000267A) which status is Expired.
| Name | Blackford, Dianne E. |
|---|---|
| License Number | 15000267A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | Elwood |
| State | IN |