Provider Demographics
NPI:1316367014
Name:LIGHTFOOT, LEATRICE (NP)
Entity Type:Individual
Prefix:
First Name:LEATRICE
Middle Name:
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 RONKONKOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-4319
Mailing Address - Country:US
Mailing Address - Phone:917-664-4321
Mailing Address - Fax:
Practice Address - Street 1:504 RONKONKOMA AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-4319
Practice Address - Country:US
Practice Address - Phone:917-664-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily