Individual
LORRAINE A CHAMPION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3555 ROUND BARN CIR, SANTA ROSA, CA 95403
(707) 528-1050
(707) 525-3874
Mailing address
3555 ROUND BARN CIR, SANTA ROSA, CA 95403-1757
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
062956
GA
174400000X
Specialist
Primary
A36803
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A368030
—
CA
05
—
01318995
—
GA
Enumeration date
10/31/2005
Last updated
01/25/2021
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