Provider Demographics
NPI:1952143356
Name:WOOLFOLK, MYKIA N
Entity type:Individual
Prefix:
First Name:MYKIA
Middle Name:N
Last Name:WOOLFOLK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 E GRAND BLVD UNIT 369
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48211-2003
Mailing Address - Country:US
Mailing Address - Phone:313-740-2951
Mailing Address - Fax:
Practice Address - Street 1:1154 W FOREST AVE APT 2B
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-3600
Practice Address - Country:US
Practice Address - Phone:313-740-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula