Provider Demographics
NPI:1861276818
Name:LIGHTFOOT, MARIA ANGELINA (RN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELINA
Last Name:LIGHTFOOT
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 1:23206 WOODLAWN RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2262
Mailing Address - Country:US
Mailing Address - Phone:210-842-5467
Mailing Address - Fax:
Practice Address - Street 1:22610 US HIGHWAY 281 N STE 206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7562
Practice Address - Country:US
Practice Address - Phone:210-860-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX913165163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse