Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APN.0995488-NP | CO |
NPI | 1366063224 |
---|---|
Provider Name | Deborah Caroline Lucero |
First Address | Longmont, CO 80504-3706 |
Second Address | Longmont, CO 80504-3706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2020 |
Last Update Date | 01/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
95-093-2243 | DRIVER'S LICENSE (01) | CO |