Provider Demographics
NPI:1184987042
Name:LO, ZACHARY S (RN NP-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:S
Last Name:LO
Suffix:
Gender:M
Credentials:RN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1021 DARRINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8158
Mailing Address - Country:US
Mailing Address - Phone:984-333-2741
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:1021 DARRINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8158
Practice Address - Country:US
Practice Address - Phone:984-333-2741
Practice Address - Fax:919-378-9114
Is Sole Proprietor?:No
Enumeration Date:2012-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21573363LC1500X, 363LF0000X
NC5013959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184987042Medicaid
NCML2786614OtherDEA