Provider Demographics
NPI:1467095471
Name:LUCERO, JAIME R (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:R
Last Name:LUCERO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 OSUNA RD NE STE 5C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2072
Mailing Address - Country:US
Mailing Address - Phone:505-585-2345
Mailing Address - Fax:
Practice Address - Street 1:8400 OSUNA RD NE STE 5C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2072
Practice Address - Country:US
Practice Address - Phone:505-585-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56379363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner