Provider Demographics
NPI:1164260188
Name:RUSS, JORNAYSIA EDNIECE (RN)
Entity type:Individual
Prefix:MRS
First Name:JORNAYSIA
Middle Name:EDNIECE
Last Name:RUSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JORNAYSIA
Other - Middle Name:EDNIECE
Other - Last Name:GOWINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3065 SIGNATURE BLVD APT G
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:426 N INGALLS ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2003
Practice Address - Country:US
Practice Address - Phone:734-763-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704417682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse