Provider Demographics
NPI:1225058076
Name:WIPFF FOUTS, LOREN (CNM)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:WIPFF FOUTS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 CREST DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-2217
Mailing Address - Country:US
Mailing Address - Phone:707-494-0601
Mailing Address - Fax:
Practice Address - Street 1:401 BICENTENNIAL WAY
Practice Address - Street 2:HOSPITAL, 3RD FLOOR, LABOR AND DELIVERY
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-393-4632
Practice Address - Fax:707-393-4487
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1745367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife