Provider Demographics
NPI:1275594574
Name:LUCERO, ANNA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
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 1:7250 NINTH ST
Mailing Address - Street 2:
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-6011
Mailing Address - Country:US
Mailing Address - Phone:915-877-4217
Mailing Address - Fax:915-877-4231
Practice Address - Street 1:950 ANTHONY ST
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-6052
Practice Address - Country:US
Practice Address - Phone:915-877-4217
Practice Address - Fax:915-877-4231
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP7151OtherBLUE CROSS BLUE SHIELD
TX121401704Medicaid
TX121401705Medicaid
TX121401705Medicaid
TX610832Medicare PIN