Healthcare Provider Details

I. General information

NPI: 1154576189
Provider Name (Legal Business Name): LINDSEY LUCERO APNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 S GIBSON ST
MEDFORD WI
54451-1622
US

IV. Provider business mailing address

3430 E MAIN ST
MERRILL WI
54452-9001
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-2121
  • Fax:
Mailing address:
  • Phone: 715-393-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number150645-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7259
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: