Basic Information
| Provider Information | |||||||||
| NPI: | 1134540974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCERO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672033602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607600 | ||||||||
| FaxNumber: | 3166607510 | ||||||||
| Practice Location | |||||||||
| Address1: | 2716 W CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672034904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607357 | ||||||||
| FaxNumber: | 3166601928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2013 | ||||||||
| LastUpdateDate: | 12/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 25764 | KS | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.