MEDICARE: TIFFANY MARIE PERRY CD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	85446	NM
2	374J00000X	Doula

General Provider Information

NPI Number	:	1114752177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MARIE PERRY CD

Provider Business Mailing Address
First Line	:	1025 RIVERSTONE RD TRLR 8
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-2881
Country	:	US
Telephone Number	:	505-716-2227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 RIVERSTONE RD TRLR 8
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-2881
Country	:	US
Telephone Number	:	505-716-2227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2024
Last Update Date	:	08/22/2025

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