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General NPI Number Information
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NPI Number | 1730420449
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Entity Type | Individual
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Provider Name | CAROLYN V LO ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 5900 COYLE AVE STE A
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City | CARMICHAEL
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State | CA
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Zip | 95608-0400
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Country | US
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Telephone | 916-414-9055
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Fax | 916-414-9054
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Provider Business Mailing Address
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Address Line | 7466 SACHI WAY
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City | SACRAMENTO
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State | CA
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Zip | 95823-3964
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Country | US
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Telephone | 650-441-5539
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP13965
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 13965
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 428050
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License Number State | CA
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