Provider Demographics
NPI:1952900631
Name:MCQUEEN, MARQUISE CATHERINE
Entity Type:Individual
Prefix:MS
First Name:MARQUISE
Middle Name:CATHERINE
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARQUISE
Other - Middle Name:CATHERINE
Other - Last Name:MCQUEEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30800 NORTHWESTERN HWY STE 230
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2550
Mailing Address - Country:US
Mailing Address - Phone:248-571-9025
Mailing Address - Fax:
Practice Address - Street 1:30800 NORTHWESTERN HWY STE 230
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2550
Practice Address - Country:US
Practice Address - Phone:248-571-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9390788Medicaid