Provider Demographics
NPI:1609369297
Name:LUCERO, ISAAC (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:LUCERO
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 MALL DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-522-0660
Mailing Address - Fax:
Practice Address - Street 1:1141 MALL DR STE E
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8194
Practice Address - Country:US
Practice Address - Phone:575-288-7068
Practice Address - Fax:575-522-3151
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-72919163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty