Provider Demographics
NPI:1912481318
Name:LIGHTEN, GEARLDEAN
Entity Type:Individual
Prefix:
First Name:GEARLDEAN
Middle Name:
Last Name:LIGHTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEARLDEAN
Other - Middle Name:
Other - Last Name:HIGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:727 EVERETT LOOP APT B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-5500
Mailing Address - Country:US
Mailing Address - Phone:318-557-9896
Mailing Address - Fax:
Practice Address - Street 1:727 EVERETT LOOP APT B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-5500
Practice Address - Country:US
Practice Address - Phone:318-557-9896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN159035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse