Provider Demographics
NPI:1265900930
Name:PERINI, LYRAE (MSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LYRAE
Middle Name:
Last Name:PERINI
Suffix:
Gender:F
Credentials:MSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5351 S BIG HORN PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-6081
Mailing Address - Country:US
Mailing Address - Phone:480-584-9473
Mailing Address - Fax:
Practice Address - Street 1:5351 S BIG HORN PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-6081
Practice Address - Country:US
Practice Address - Phone:480-584-9473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-24592163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant