Provider Demographics
NPI:1073295622
Name:THOMPSON, TRACIE LADONYA
Entity Type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:LADONYA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BROADUS ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1384
Mailing Address - Country:US
Mailing Address - Phone:877-659-4500
Mailing Address - Fax:888-972-3891
Practice Address - Street 1:215 BROADUS ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1384
Practice Address - Country:US
Practice Address - Phone:877-659-4500
Practice Address - Fax:888-972-3891
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide