Provider Demographics
NPI:1578550364
Name:CANANT, TRACY LOZON (RD/LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LOZON
Last Name:CANANT
Suffix:
Gender:F
Credentials:RD/LD, CDE
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:CANANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/LD, CDE
Mailing Address - Street 1:57267 S 725 RD
Mailing Address - Street 2:
Mailing Address - City:COLCORD
Mailing Address - State:OK
Mailing Address - Zip Code:74338-1123
Mailing Address - Country:US
Mailing Address - Phone:918-696-8806
Mailing Address - Fax:918-696-8840
Practice Address - Street 1:RR 6 BOX 840
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-8703
Practice Address - Country:US
Practice Address - Phone:918-696-8806
Practice Address - Fax:918-696-8840
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK778133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered