Healthcare Provider Details

I. General information

NPI: 1992669592
Provider Name (Legal Business Name): MARQUES RAYFORD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22205 60TH AVE
MATTAWAN MI
49071-9527
US

IV. Provider business mailing address

22205 60TH AVE
MATTAWAN MI
49071-9527
US

V. Phone/Fax

Practice location:
  • Phone: 269-280-8899
  • Fax:
Mailing address:
  • Phone: 269-280-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704390108
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: