Provider Demographics
NPI:1326819921
Name:KLOSNER, JACQUELINE JEANNETTE (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JEANNETTE
Last Name:KLOSNER
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 1:7050 STATE HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-3203
Mailing Address - Country:US
Mailing Address - Phone:315-985-3868
Mailing Address - Fax:
Practice Address - Street 1:7050 STATE HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-3203
Practice Address - Country:US
Practice Address - Phone:315-985-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY445289364SH1100X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic