Provider Demographics
NPI:1245112671
Name:WEATHERSPOON, LORENZO (CFSA,CNA)
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:WEATHERSPOON
Suffix:
Gender:M
Credentials:CFSA,CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 IVIS AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-3430
Mailing Address - Country:US
Mailing Address - Phone:251-776-3584
Mailing Address - Fax:
Practice Address - Street 1:605 IVIS AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-3430
Practice Address - Country:US
Practice Address - Phone:251-776-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8430376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1790358703Medicaid