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General NPI Number Information
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NPI Number | 1235220120
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Entity Type | Individual
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Provider Name | ERIN WILLIS LOUCKS M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 4835 DODGE ST
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City | OMAHA
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State | NE
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Zip | 68132-3133
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Country | US
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Telephone | 402-955-7676
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 DODGE STREET
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City | OMAHA
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State | NE
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Zip | 68132
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Country | US
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Telephone | 402-955-7676
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Fax | 402-955-7679
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 22785
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License Number State | NE
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