Provider Demographics
NPI:1902478316
Name:TOPULLI, MARY LORRAINE VITO (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LORRAINE VITO
Last Name:TOPULLI
Suffix:
Gender:F
Credentials:AGACNP-BC
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Other - First Name:
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Mailing Address - Street 1:4100 JOHN R ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2013
Mailing Address - Country:US
Mailing Address - Phone:313-576-8061
Mailing Address - Fax:313-576-8424
Practice Address - Street 1:4100 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:313-576-8071
Practice Address - Fax:313-576-8424
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304548363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner