Provider Demographics
NPI:1417832643
Name:WEATHERSPOON, TRACEY M
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:WEATHERSPOON
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 1:727 W GRAND BLVD APT 125
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-2124
Mailing Address - Country:US
Mailing Address - Phone:313-289-9180
Mailing Address - Fax:
Practice Address - Street 1:727 W GRAND BLVD APT 125
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-2124
Practice Address - Country:US
Practice Address - Phone:313-289-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula