Healthcare Provider Details

I. General information

NPI: 1568237485
Provider Name (Legal Business Name): ASHLEA MARIA LUCERO FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EUBANK BLVD NE STE A
ALBUQUERQUE NM
87111-3590
US

IV. Provider business mailing address

3825 EUBANK BLVD NE STE A
ALBUQUERQUE NM
87111-3590
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-8575
  • Fax: 505-292-8409
Mailing address:
  • Phone: 505-292-8575
  • Fax: 505-292-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number76832
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: