Provider Demographics
NPI:1174333082
Name:PERI, MCKENNA L (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:L
Last Name:PERI
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 1:4136 KATHLEEN DENISE LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1030
Mailing Address - Country:US
Mailing Address - Phone:775-220-1690
Mailing Address - Fax:
Practice Address - Street 1:4136 KATHLEEN DENISE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-1030
Practice Address - Country:US
Practice Address - Phone:775-220-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVL-307481174N00000X
NV67480163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN