Provider Demographics
NPI:1477822062
Name:LIGHTFOOTE, ELLEN G (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:G
Last Name:LIGHTFOOTE
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 1:4100 BALDWIN ROAD
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9799
Mailing Address - Country:US
Mailing Address - Phone:585-554-6442
Mailing Address - Fax:585-554-3414
Practice Address - Street 1:4100 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544-9738
Practice Address - Country:US
Practice Address - Phone:585-554-6442
Practice Address - Fax:585-554-3414
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275390-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse