Provider Demographics
NPI:1326380668
Name:LUCERO, MISTY LEE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LEE
Last Name:LUCERO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4403 CORTE BRUMOSO
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5859
Mailing Address - Country:US
Mailing Address - Phone:520-508-1794
Mailing Address - Fax:
Practice Address - Street 1:5750 E HIGHWAY 90 STE 300B
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-9114
Practice Address - Country:US
Practice Address - Phone:520-263-3620
Practice Address - Fax:520-263-3619
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP4897367A00000X
AZ367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife