Provider Demographics
NPI:1891359667
Name:KLOSTER, KRISTA LEIGH
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEIGH
Last Name:KLOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7472 HODGE RD
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-2331
Mailing Address - Country:US
Mailing Address - Phone:315-681-0114
Mailing Address - Fax:
Practice Address - Street 1:6537 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:GLENFIELD
Practice Address - State:NY
Practice Address - Zip Code:13343-4120
Practice Address - Country:US
Practice Address - Phone:315-783-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646008-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse