Healthcare Provider Details

I. General information

NPI: 1801311907
Provider Name (Legal Business Name): SARA KATELYNN LUCERO RN, MSN, ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

2437 ZENA LONA ST NE
ALBUQUERQUE NM
87112-1973
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2111
  • Fax:
Mailing address:
  • Phone: 505-235-4091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberCNP-03335
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: