Provider Demographics
NPI:1891936175
Name:HAYNES, TRACI RENEE (RD)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:RENEE
Last Name:HAYNES
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 1:157 VIA MISSION DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4304
Mailing Address - Country:US
Mailing Address - Phone:530-828-2763
Mailing Address - Fax:
Practice Address - Street 1:341 BROADWAY ST STE 224
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5342
Practice Address - Country:US
Practice Address - Phone:530-828-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered