Provider Demographics
NPI:1346559218
Name:LIGHTFOOT-TAYLOR, GENEVIEVE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:LIGHTFOOT-TAYLOR
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 DEFENSE HWY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8955
Mailing Address - Country:US
Mailing Address - Phone:410-987-2003
Mailing Address - Fax:410-837-1525
Practice Address - Street 1:445 DEFENSE HWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-8955
Practice Address - Country:US
Practice Address - Phone:410-987-2003
Practice Address - Fax:410-837-1525
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR118703163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8442123OtherAETNA HMO
MD9144622OtherAETNA PPO
MD259796OtherJHHC PRODUCTS
MD442307100Medicaid
MDX697 AND CB6XPAOtherCAREFIRST
MD8442123OtherAETNA HMO