Provider Demographics
NPI:1003036203
Name:GAROFALO, KATHLEEN E (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:E
Last Name:GAROFALO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3173 ALEX LA.
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027
Mailing Address - Country:US
Mailing Address - Phone:315-685-4437
Mailing Address - Fax:315-685-4034
Practice Address - Street 1:4341 STATE STREET RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES FALLS
Practice Address - State:NY
Practice Address - Zip Code:13153-5300
Practice Address - Country:US
Practice Address - Phone:315-685-4437
Practice Address - Fax:315-685-4064
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302957-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health