Provider Demographics
NPI:1790420776
Name:LUCE, BEVERLY KAY (RN, CCM)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:KAY
Last Name:LUCE
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 GROSENBACHER RD LOT 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3640
Mailing Address - Country:US
Mailing Address - Phone:210-854-5754
Mailing Address - Fax:
Practice Address - Street 1:4745 GROSENBACHER RD LOT 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-3640
Practice Address - Country:US
Practice Address - Phone:210-854-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX646378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse