Provider Demographics
NPI:1336958917
Name:TRUSS, JAMAL DE'SEAN
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:DE'SEAN
Last Name:TRUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GRADOLPH ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1420
Mailing Address - Country:US
Mailing Address - Phone:419-315-5945
Mailing Address - Fax:
Practice Address - Street 1:130 GRADOLPH ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1420
Practice Address - Country:US
Practice Address - Phone:419-315-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker