Provider Demographics
NPI:1780019299
Name:PATTON, LACEY R (RD)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:R
Last Name:PATTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 AURORA CT
Mailing Address - Street 2:MAIL STOP F743
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2541
Mailing Address - Country:US
Mailing Address - Phone:720-848-1090
Mailing Address - Fax:720-848-1277
Practice Address - Street 1:1635 AURORA CT
Practice Address - Street 2:SUITE 5501
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:720-848-1090
Practice Address - Fax:720-848-1277
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO979552133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered