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General NPI Number Information
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NPI Number | 1437058229
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Entity Type | Individual
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Provider Name | LISA MARIE SEAWAY PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2026
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 3024 E EMPIRE ST FL 2
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City | BLOOMINGTON
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State | IL
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Zip | 61704-5402
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Country | US
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Telephone | 309-556-7800
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Fax | 309-556-7804
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Provider Business Mailing Address
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Address Line | 7 BROOKSHIRE GRN
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City | BLOOMINGTON
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State | IL
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Zip | 61704-6211
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Country | US
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Telephone | 309-556-7800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209032788
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License Number State | IL
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