The holder whose full name is SMITH, JANE M,come from LAFAYETTE IN,hold the Preceptor Eligible license(NO.15003814A) which status is Expired.
| Name | SMITH, JANE M |
|---|---|
| License Number | 15003814A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | LAFAYETTE |
| State | IN |