The holder whose full name is Wakefield, Tara Suzanne,come from Indianapolis IN,hold the Temporary MD Permit license(NO.99051622A) which status is Superceded.
| Name | Wakefield, Tara Suzanne |
|---|---|
| License Number | 99051622A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Indianapolis |
| State | IN |