Provider Demographics
NPI:1588099287
Name:SPILLETT, KATHLEEN A (CNM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:SPILLETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:MCHC OB GYN, POB STE 706
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-703-5200
Mailing Address - Fax:315-703-5201
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:MCHC OB GYN, POB STE 706
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-703-5200
Practice Address - Fax:315-703-5201
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife