Healthcare Provider Details

I. General information

NPI: 1407794225
Provider Name (Legal Business Name): MINDY LO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TEXAS STATION CT STE 210
TIMONIUM MD
21093-8288
US

IV. Provider business mailing address

525 N WOLFE ST
BALTIMORE MD
21205-2110
US

V. Phone/Fax

Practice location:
  • Phone: 410-683-3380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR255308
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: