Individual
ERNEST EUGENE LISSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1375 N 10TH AVE, STAYTON, OR 97383-2099
(503) 769-2641
(503) 769-3797
Mailing address
1375 N 10TH AVE, STAYTON, OR 97383-2099
(503) 769-2641
(503) 769-3797
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200450135NP FNP-PP
OR
Other
Enumeration date
11/10/2005
Last updated
01/05/2012
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