Provider Demographics
NPI:1366063224
Name:LUCERO, DEBORAH CAROLINE (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CAROLINE
Last Name:LUCERO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 PROVENANCE ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-3706
Mailing Address - Country:US
Mailing Address - Phone:970-402-5272
Mailing Address - Fax:
Practice Address - Street 1:2310 PROVENANCE ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-3706
Practice Address - Country:US
Practice Address - Phone:970-402-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995488-NP363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95-093-2243OtherDRIVER'S LICENSE