Cathy Diane Lisenby, PA-C
Physician Assistant in Mount Vernon, IL. Individual provider (NPI-1).
NPI number1346356524
StatusActive
Last updated in NPPESDec 18, 2020
Details
- NPI
- 1346356524
- Entity type
- Individual (NPI-1)
- Name
- Ms. Cathy Diane Lisenby
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 21, 2006
- Certification date
- Dec 18, 2020
- Last updated
- Dec 18, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 0850001397 | IL | Yes |
Practice location
2 Good Samaritan WayMount Vernon, IL 62864-2408
Phone 618-899-4000 · Fax 618-899-4790
Mailing address
5100 Lake Ter Ne Ste WcMount Vernon, IL 62864-9665
Phone 618-899-5001 · Fax 618-242-5152
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All 12 Physician Assistant providers in Mount Vernon · All 834 providers in Mount Vernon
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