Provider Demographics
NPI:1184429938
Name:MANSON, MICHELLE (RDN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MANSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 INGALLS DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-3261
Mailing Address - Country:US
Mailing Address - Phone:262-945-3022
Mailing Address - Fax:
Practice Address - Street 1:4423 INGALLS DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-3261
Practice Address - Country:US
Practice Address - Phone:262-945-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO954515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered