Provider Demographics
NPI:1104247055
Name:LUCERO, BERTHA (RN)
Entity type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 W COMPRESS RD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-9270
Mailing Address - Country:US
Mailing Address - Phone:575-746-9816
Mailing Address - Fax:575-146-4365
Practice Address - Street 1:89 W COMPRESS RD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-9270
Practice Address - Country:US
Practice Address - Phone:575-746-9816
Practice Address - Fax:575-146-4365
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR38002163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool