Provider Demographics
NPI:1174252779
Name:KLOSTER, STACI RAE (RDN)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:RAE
Last Name:KLOSTER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20615 EAGLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8748
Mailing Address - Country:US
Mailing Address - Phone:907-903-3707
Mailing Address - Fax:
Practice Address - Street 1:3909 ARCTIC BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5769
Practice Address - Country:US
Practice Address - Phone:907-644-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK196197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty