Provider Demographics
NPI:1700660743
Name:FYFFE, ERIN RAE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:RAE
Last Name:FYFFE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9345 W VIA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2966
Mailing Address - Country:US
Mailing Address - Phone:623-256-9000
Mailing Address - Fax:
Practice Address - Street 1:9345 W VIA DEL SOL
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2966
Practice Address - Country:US
Practice Address - Phone:623-256-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN140759163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant