Healthcare Provider Details

I. General information

NPI: 1770426959
Provider Name (Legal Business Name): MONIQUE BOYKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 E MICHIGAN AVE # 1257
LANSING MI
48912-4616
US

IV. Provider business mailing address

1664 AURELIUS RD APT 1
HOLT MI
48842-1953
US

V. Phone/Fax

Practice location:
  • Phone: 517-242-0684
  • Fax:
Mailing address:
  • Phone: 517-242-0684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: