Healthcare Provider Details

I. General information

NPI: 1295333508
Provider Name (Legal Business Name): AMY RHEA LUCERO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 S WALNUT ST BLDG 3
LAS CRUCES NM
88001-1425
US

IV. Provider business mailing address

1271 FOUNTAIN LOOP
LAS CRUCES NM
88007-8093
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-3980
  • Fax:
Mailing address:
  • Phone: 575-644-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP61519
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: