The holder whose full name is BLACK, LISA ANN,come from Fort Wayne IN,hold the Temporary RN Permit license(NO.99006441A) which status is Superceded.
| Name | BLACK, LISA ANN |
|---|---|
| License Number | 99006441A |
| License Type | Temporary RN Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |