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NPI Code Detail

MEDICARE: MS. MARQUITA MONIQUE MCCULLOUGH LPN

MEDICARE: MS. MARQUITA MONIQUE MCCULLOUGH LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse4703111212MI
2163WP0808XPsychiatric/Mental Health Registered Nurse4704340478MI

General Provider Information

NPI Number : 1114339314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARQUITA MONIQUE MCCULLOUGH LPN
Provider Business Mailing Address
First Line : 34290 FORD RD
Second Line :
City : WESTLAND
State : MI
Zip : 48185-3051
Country : US
Telephone Number : 734-412-8800
Fax Number :
Provider Business Practice Location Address
First Line : 34290 FORD RD
Second Line :
City : WESTLAND
State : MI
Zip : 48185-3051
Country : US
Telephone Number : 734-412-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2014
Last Update Date : 04/07/2026

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