Individual
MS. CATHY DIANE LISENBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2 GOOD SAMARITAN WAY, MOUNT VERNON, IL 62864-2408
(618) 899-4000
(618) 899-4790
Mailing address
5100 LAKE TER NE STE WC, MOUNT VERNON, IL 62864-9665
(618) 899-5001
(618) 242-5152
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0850001397
IL
Other
Enumeration date
08/21/2006
Last updated
12/18/2020
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