Provider Demographics
NPI:1518553981
Name:FYE, LORRAINE ROSE (RD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:ROSE
Last Name:FYE
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:MISS
Other - First Name:LORRAINE
Other - Middle Name:ROSE
Other - Last Name:MERICLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CNSC
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5499
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5499
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86082284133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered