Healthcare Provider Details

I. General information

NPI: 1184557860
Provider Name (Legal Business Name): MARQUITA R JUDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N ROCHESTER RD
CLAWSON MI
48017-1743
US

IV. Provider business mailing address

129 N ROCHESTER RD
CLAWSON MI
48017-1743
US

V. Phone/Fax

Practice location:
  • Phone: 248-821-9868
  • Fax:
Mailing address:
  • Phone: 248-821-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License NumberSFE3963362862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: