Provider Demographics
NPI:1801693429
Name:MCQUEEN, MARLIN
Entity type:Individual
Prefix:
First Name:MARLIN
Middle Name:
Last Name:MCQUEEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1138
Mailing Address - Country:US
Mailing Address - Phone:313-415-1023
Mailing Address - Fax:
Practice Address - Street 1:11650 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1138
Practice Address - Country:US
Practice Address - Phone:313-415-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty