| Doctor Name: | ERNEST EUGENE LISSY |
| NPI Number: | 1013998475 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 200450135NP FNP-PP |
| Business Practice Address: | 1375 N 10th Ave Stayton, OR - 973832099 |
| Business Phone Number: | 5037692641 |
| Business Fax Number: | 5037693797 |
| Mailing Address: | 1375 N 10th Ave, STAYTON |
| State: | OR |
| Postal Code: | 973832099 |
| Phone Number: | 5037692641 |
| Fax Number: | 5037693797 |
| NPI Enumeration Date: | 11/10/2005 |
| NPI Last Update Date: | 01/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 200450135NP FNP-PP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |