Individual
MARY LOU POPOLIZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1425 PORTLAND AVE, RGPA, ROCHESTER, NY 14621-3001
(585) 922-2575
Mailing address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-2575
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
277948
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02565222
—
NY
Enumeration date
07/16/2006
Last updated
06/05/2012
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