Healthcare Provider Details

I. General information

NPI: 1134094972
Provider Name (Legal Business Name): MAKAYLA BOLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1200 N WEST AVE
JACKSON MI
49202-2179
US

IV. Provider business mailing address

1312 W PARNALL RD
JACKSON MI
49201-8660
US

V. Phone/Fax

Practice location:
  • Phone: 800-284-8288
  • Fax: 800-284-8288
Mailing address:
  • Phone: 800-284-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: