Healthcare Provider Details

I. General information

NPI: 1114494887
Provider Name (Legal Business Name): LISA SEAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N DIERS AVE STE 3
GRAND ISLAND NE
68803-4910
US

IV. Provider business mailing address

1704 HUDSON CIR
GRAND ISLAND NE
68801-7473
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-4452
  • Fax:
Mailing address:
  • Phone: 308-340-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2124
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: