Provider Demographics
NPI:1508433640
Name:CHILLUFFO, KATHRYN (RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CHILLUFFO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 SHELLS BUSH RD
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-4020
Mailing Address - Country:US
Mailing Address - Phone:315-717-9494
Mailing Address - Fax:
Practice Address - Street 1:1151 ALBANY ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-3372
Practice Address - Country:US
Practice Address - Phone:315-368-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718194163WM0705X
390200000X
NY718149163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program