=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922048859
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA A PATTISON PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 05/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3280 WOODRIDGE BLVD SUITE 200
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68801-5194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-382-1764
-----------------------------------------------------
Fax | 308-395-3730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5194 3280 WOODRIDGE BLVD SUITE 200
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68802-5194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-382-1764
-----------------------------------------------------
Fax | 308-395-3730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 325
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------