Provider Demographics
NPI:1508433640
Name:CHILLUFFO, KATHRYN (CNM)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CHILLUFFO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1718
Mailing Address - Country:US
Mailing Address - Phone:315-717-9494
Mailing Address - Fax:
Practice Address - Street 1:107 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2834
Practice Address - Country:US
Practice Address - Phone:315-334-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718194163WM0705X
NY718149163WS0200X
390200000X
NY002328176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program