Provider Demographics
NPI:1043413719
Name:DOMEYER, LORNA
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:
Last Name:DOMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORNA
Other - Middle Name:
Other - Last Name:ODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7235 MACHADO LN
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:CA
Mailing Address - Zip Code:96064-9724
Mailing Address - Country:US
Mailing Address - Phone:530-459-3740
Mailing Address - Fax:
Practice Address - Street 1:7235 MACHADO LN
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:CA
Practice Address - Zip Code:96064-9724
Practice Address - Country:US
Practice Address - Phone:530-459-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator