Healthcare Provider Details

I. General information

NPI: 1235220120
Provider Name (Legal Business Name): ERIN WILLIS LOUCKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/26/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 DODGE ST
OMAHA NE
68132-3133
US

IV. Provider business mailing address

4325 DODGE STREET
OMAHA NE
68132
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-7676
  • Fax:
Mailing address:
  • Phone: 402-955-7676
  • Fax: 402-955-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22785
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: