The holder whose full name is Black, Marie L.,come from Greenwood IN,hold the Temporary LPN Permit license(NO.99059805A) which status is Superceded.
| Name | Black, Marie L. |
|---|---|
| License Number | 99059805A |
| License Type | Temporary LPN Permit |
| License Status | Superceded |
| City | Greenwood |
| State | IN |