Provider Demographics
NPI:1043988827
Name:LIGHTFOOT, SHARENA (LMT, LPN)
Entity Type:Individual
Prefix:
First Name:SHARENA
Middle Name:
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:LMT, LPN
Other - Prefix:
Other - First Name:SHARENA
Other - Middle Name:L
Other - Last Name:LIGHTFOOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN, LMT
Mailing Address - Street 1:712 WILCREST DR STE 171
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1348
Mailing Address - Country:US
Mailing Address - Phone:985-709-7955
Mailing Address - Fax:
Practice Address - Street 1:1911 WESTMEAD DR APT 2305
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4717
Practice Address - Country:US
Practice Address - Phone:985-709-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-05
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20170679164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse