Provider Demographics
NPI:1316742497
Name:LUCERO, JENNIFER A (CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:LUCERO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:AMANDA
Other - Last Name:AREBALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1191 FESTIVAL RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8578
Mailing Address - Country:US
Mailing Address - Phone:505-974-1611
Mailing Address - Fax:
Practice Address - Street 1:3630 LAS ESTANCIAS DR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5504
Practice Address - Country:US
Practice Address - Phone:505-462-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM82822363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics