Provider Demographics
NPI:1740595792
Name:LO, TAMMY WEN-CHUN (ACNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:WEN-CHUN
Last Name:LO
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3807
Mailing Address - Country:US
Mailing Address - Phone:203-824-8226
Mailing Address - Fax:
Practice Address - Street 1:25 VALLEY DR
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5203
Practice Address - Country:US
Practice Address - Phone:203-661-3333
Practice Address - Fax:203-661-5610
Is Sole Proprietor?:No
Enumeration Date:2010-08-15
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5568363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care