Provider Demographics
NPI:1487892287
Name:LO, DONNA KAY (CNM)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KAY
Last Name:LO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-760-2821
Mailing Address - Fax:
Practice Address - Street 1:3518 DRAWBRIDGE PKWY STE 310
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8432
Practice Address - Country:US
Practice Address - Phone:336-890-3180
Practice Address - Fax:336-890-2937
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12825367A00000X
NC429367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7002175Medicaid
NC2594338BMedicare PIN