Individual
JADE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2205 W MORRELL ST, JACKSON, MI 49203-1357
(716) 622-1523
Mailing address
2205 W MORRELL ST, JACKSON, MI 49203-1357
(716) 622-1523
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704330743
MI
Other
Enumeration date
08/10/2020
Last updated
08/10/2020
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