Healthcare Provider Details

I. General information

NPI: 1154007797
Provider Name (Legal Business Name): JAHNAY TIPPINS-MORRIS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAH NAY MORRIS LPN

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17131 INDIANA ST
DETROIT MI
48221-2444
US

IV. Provider business mailing address

17131 INDIANA ST
DETROIT MI
48221-2444
US

V. Phone/Fax

Practice location:
  • Phone: 313-490-5454
  • Fax:
Mailing address:
  • Phone: 313-490-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703123967
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: