Provider Demographics
NPI:1932601341
Name:LUCERO, JOHN (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LUCERO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 JASON CRANDALL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5350
Mailing Address - Country:US
Mailing Address - Phone:915-241-1655
Mailing Address - Fax:
Practice Address - Street 1:221 N KANSAS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1443
Practice Address - Country:US
Practice Address - Phone:915-213-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM844440163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health