Provider Demographics
NPI:1730420449
Name:LO, CAROLYN V (ANP-BC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:V
Last Name:LO
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:L
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:7466 SACHI WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-3964
Mailing Address - Country:US
Mailing Address - Phone:650-441-5539
Mailing Address - Fax:
Practice Address - Street 1:5900 COYLE AVE STE A
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0400
Practice Address - Country:US
Practice Address - Phone:916-414-9055
Practice Address - Fax:916-414-9054
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428050163W00000X
CANP13965363L00000X
CA13965363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner