Provider Demographics
NPI:1275569261
Name:THOMPSON, TRACI ANN (MA, RD)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E HIGHLINE CIR
Mailing Address - Street 2:#305
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1055
Mailing Address - Country:US
Mailing Address - Phone:303-205-0546
Mailing Address - Fax:
Practice Address - Street 1:230 E HIGHLINE CIR
Practice Address - Street 2:#305
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1055
Practice Address - Country:US
Practice Address - Phone:303-205-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered