Healthcare Provider Details

I. General information

NPI: 1417362997
Provider Name (Legal Business Name): COURTNEY LOECKER APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST SUITE 506
LINCOLN NE
68506-1276
US

IV. Provider business mailing address

1500 S 48TH ST SUITE 506
LINCOLN NE
68506-1276
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-1110
  • Fax: 402-489-8492
Mailing address:
  • Phone: 402-489-1110
  • Fax: 402-489-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number111667
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: