Provider Demographics
NPI:1245994755
Name:LIGHTFOOT-TAYLOR, MELISA PHEBEAN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:PHEBEAN
Last Name:LIGHTFOOT-TAYLOR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 APPLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1739
Mailing Address - Country:US
Mailing Address - Phone:908-421-1916
Mailing Address - Fax:
Practice Address - Street 1:132 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2484
Practice Address - Country:US
Practice Address - Phone:732-452-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12444300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse