Healthcare Provider Details

I. General information

NPI: 1902689474
Provider Name (Legal Business Name): NATHAN LOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE NURSE ANESTHE 525 VINE ST, SUITE 230
WINSTON SALEM NC
27101
US

IV. Provider business mailing address

WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE NURSE ANESTHE 525 VINE ST, SUITE 230
WINSTON SALEM NC
27101
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-1411
  • Fax:
Mailing address:
  • Phone: 336-716-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP70045393
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: