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General NPI Number Information
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NPI Number | 1023872827
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE PRIMARY CARE, LLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 1288 S GOVERNORS AVE STE B
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City | DOVER
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State | DE
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Zip | 19904-4802
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Country | US
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Telephone | 302-674-4545
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Fax | 800-507-3166
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Provider Business Mailing Address
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Address Line | PO BOX 515
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City | DOVER
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State | DE
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Zip | 19903-0515
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Country | US
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Telephone | 302-674-4545
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Fax | 800-507-3166
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Authorized Official
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Title or Position | DNP, APRN, FNP-C
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Name | SANDRA EGGLESTON
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Credential |
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Telephone | 302-674-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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