Provider Demographics
NPI:1013571652
Name:LUCERO, DONNA (FNP-C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22269 W MOONLIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8591
Mailing Address - Country:US
Mailing Address - Phone:623-388-4754
Mailing Address - Fax:
Practice Address - Street 1:9897 W MCDOWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1622
Practice Address - Country:US
Practice Address - Phone:623-474-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ224620Medicaid