Provider Demographics
NPI:1003205923
Name:LIGHTFOOT, STEFANIE (RN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3717
Mailing Address - Country:US
Mailing Address - Phone:318-256-4119
Mailing Address - Fax:318-256-4171
Practice Address - Street 1:265 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3717
Practice Address - Country:US
Practice Address - Phone:318-256-4119
Practice Address - Fax:318-256-4171
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN108691163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse