Basic Information
| Provider Information | |||||||||
| NPI: | 1003205923 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIGHTFOOT | ||||||||
| FirstName: | STEFANIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 265 HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182564119 | ||||||||
| FaxNumber: | 3182564171 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182564119 | ||||||||
| FaxNumber: | 3182564171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2015 | ||||||||
| LastUpdateDate: | 02/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN108691 | LA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.