Provider Demographics
NPI:1063180636
Name:LOEHRS, VICKI SUE (RE)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:SUE
Last Name:LOEHRS
Suffix:
Gender:F
Credentials:RE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5137 S. HUDSON PLACE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7506
Mailing Address - Country:US
Mailing Address - Phone:918-744-7546
Mailing Address - Fax:
Practice Address - Street 1:5137 S. HUDSON PLACE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7506
Practice Address - Country:US
Practice Address - Phone:918-744-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRE61374700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No374700000XNursing Service Related ProvidersTechnician