Provider Demographics
NPI:1295333508
Name:LUCERO, AMY RHEA (FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RHEA
Last Name:LUCERO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 FOUNTAIN LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-8093
Mailing Address - Country:US
Mailing Address - Phone:575-644-3911
Mailing Address - Fax:
Practice Address - Street 1:780 S WALNUT ST BLDG 3
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1425
Practice Address - Country:US
Practice Address - Phone:575-525-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP61519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily