Provider Demographics
NPI:1982007134
Name:LUCERO, AMANDA C (ND)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:C
Last Name:LUCERO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S 900 E SUITE 102
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3570
Mailing Address - Country:US
Mailing Address - Phone:801-997-1906
Mailing Address - Fax:888-878-0487
Practice Address - Street 1:444 S 900 E SUITE 102
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3570
Practice Address - Country:US
Practice Address - Phone:801-997-1906
Practice Address - Fax:888-878-0487
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9151051-7100175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath