Provider Demographics
NPI:1952492910
Name:LOECKER, KEVIN M (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:LOECKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-2240
Mailing Address - Country:US
Mailing Address - Phone:402-336-3469
Mailing Address - Fax:
Practice Address - Street 1:1004 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-2240
Practice Address - Country:US
Practice Address - Phone:402-336-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100845367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered