Provider Demographics
NPI:1336476563
Name:DIFULIO, KIMBERLEE ANNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:ANNE
Last Name:DIFULIO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MEADOWBROOK DRIVE #3
Mailing Address - Street 2:#3
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-876-7913
Mailing Address - Fax:
Practice Address - Street 1:1615 MEADOWBROOK DRIVE
Practice Address - Street 2:#3
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224
Practice Address - Country:US
Practice Address - Phone:315-876-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283614-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse