Provider Demographics
NPI:1487383477
Name:WOODLEY, NIKETA N
Entity type:Individual
Prefix:
First Name:NIKETA
Middle Name:N
Last Name:WOODLEY
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 1:7870 N FOUNTAIN PARK APT 206
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-4567
Mailing Address - Country:US
Mailing Address - Phone:124-888-2204
Mailing Address - Fax:
Practice Address - Street 1:17840 LAUREL PARK
Practice Address - Street 2:914
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:248-882-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7890928Medicaid