Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 41330 | CO |
NPI | 1023040011 |
---|---|
Provider Name | Jennifer L Loucks |
First Address | Englewood, CO 80113-2736 |
Second Address | Englewood, CO 80113-2736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 25/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I59058 | (02) | CO |