Provider Demographics
NPI:1952803645
Name:LIGHTFOOT, RONNELL MARKETTE
Entity Type:Individual
Prefix:MR
First Name:RONNELL
Middle Name:MARKETTE
Last Name:LIGHTFOOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 MERLE ST
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1965
Mailing Address - Country:US
Mailing Address - Phone:804-497-0098
Mailing Address - Fax:
Practice Address - Street 1:2231 MERLE ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-1965
Practice Address - Country:US
Practice Address - Phone:804-497-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care