Healthcare Provider Details

I. General information

NPI: 1578772604
Provider Name (Legal Business Name): MONICA YA-WEN LO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SHACKLEFORD WEST BLVD
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

7 SHACKLEFORD WEST BLVD
LITTLE ROCK AR
72211-3886
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-5860
  • Fax: 501-664-0889
Mailing address:
  • Phone: 501-664-5860
  • Fax: 501-664-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberE8011
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE8011
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: