Basic Information
| Provider Information | |||||||||
| NPI: | 1235887902 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LISA MCDUFFIE PSYCHIATRY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2417 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820032417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076380300 | ||||||||
| FaxNumber: | 3076380394 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 LONG DR STE A | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828013282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076730126 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2022 | ||||||||
| LastUpdateDate: | 03/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCDUFFIE | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3076730126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.