Provider Demographics
NPI:1124306667
Name:MANN, TRACY (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 S TELLURIDE CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3098
Mailing Address - Country:US
Mailing Address - Phone:402-238-5633
Mailing Address - Fax:
Practice Address - Street 1:8000 E PRENTICE AVE STE D10
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2728
Practice Address - Country:US
Practice Address - Phone:720-432-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered