Provider Demographics
NPI:1174497655
Name:LUCERO, BRIGETTE K (RN)
Entity type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:K
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552-0368
Mailing Address - Country:US
Mailing Address - Phone:505-657-1651
Mailing Address - Fax:
Practice Address - Street 1:28 PANTHER PARKWAY
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552-0368
Practice Address - Country:US
Practice Address - Phone:505-657-1651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-69727163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse