Healthcare Provider Details

I. General information

NPI: 1326380668
Provider Name (Legal Business Name): MISTY LEE LUCERO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BISBEE RD
BISBEE AZ
85603-1140
US

IV. Provider business mailing address

4403 CORTE BRUMOSO
SIERRA VISTA AZ
85635-5859
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-5838
  • Fax:
Mailing address:
  • Phone: 520-508-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAP4897
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP4897
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP4897
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberAP4897
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP4897
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: