Provider Demographics
NPI:1598787020
Name:LOUCKS, SHERRI LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYNN
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:LYNN
Other - Last Name:EASTWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4939 BRITTONFIELD PKWY
Mailing Address - Street 2:STE 202
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9208
Mailing Address - Country:US
Mailing Address - Phone:315-634-6699
Mailing Address - Fax:
Practice Address - Street 1:4939 BRITTONFIELD PKWY
Practice Address - Street 2:STE 202
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9208
Practice Address - Country:US
Practice Address - Phone:315-634-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA5743Medicare PIN
R55309Medicare UPIN