Active NPI
Holly Thull, CPNP-PC
- Pediatrics Physician
- Fraser, MI
National Provider Identifier
1437720174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 202019222
- Practice address
- 15902 Princeton CT
Fraser, MI 48026-4745 - Phone
- (586) 871-0485
- NPI assigned
- Jul 4, 2021
- Last updated
- Jul 4, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 202019222 | MI | Primary |
Addresses
Primary practice location
15902 Princeton CT
Fraser, MI 48026-4745
Mailing address
15902 Princeton CT
Fraser, MI 48026-4745
Phone (586) 871-0485
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202019222 | MI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625356800000",
"number": "1437720174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15902 PRINCETON CT",
"city": "FRASER",
"state": "MI",
"postal_code": "480264745",
"telephone_number": "586-871-0485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15902 PRINCETON CT",
"city": "FRASER",
"state": "MI",
"postal_code": "480264745",
"telephone_number": "586-871-0485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THULL",
"first_name": "HOLLY",
"credential": "CPNP-PC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-04",
"last_updated": "2021-07-04",
"certification_date": "2021-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "MI",
"license": "202019222",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fraser, MI
- Roseline Teah
- The Nurturing Providers
- Ronald Thies Jr., MD
- Thornton Chiropractic
- Gregory Thomas Thornton, D.C.
- Transitional Adult Care (Transitional Adult Care LLC)
- Trinity Continuing Care Services (fraser villa)
- Trinity Continuing Care Services (Fraser Villa)
- TTK Counseling Services, LLC
- Jason G Tuchowski, O.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.