Provider Demographics
NPI:1679209829
Name:LUCERO, NANCY LOUISE
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LOUISE
Last Name:LUCERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 HEIGHTS ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-4135
Mailing Address - Country:US
Mailing Address - Phone:979-332-1726
Mailing Address - Fax:
Practice Address - Street 1:711 HEIGHTS ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-4135
Practice Address - Country:US
Practice Address - Phone:979-332-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8TJ0-GE1-XJ03Medicaid