Provider Demographics
NPI:1972342327
Name:MANN, HALEIGH MADISON (MS, RDN)
Entity type:Individual
Prefix:
First Name:HALEIGH
Middle Name:MADISON
Last Name:MANN
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 N PENNSYLVANIA ST APT 6
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2598
Mailing Address - Country:US
Mailing Address - Phone:678-340-8928
Mailing Address - Fax:
Practice Address - Street 1:1248 N PENNSYLVANIA ST APT 6
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2598
Practice Address - Country:US
Practice Address - Phone:678-340-8928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86295807133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered