Provider Demographics
NPI:1922703271
Name:KLOSOWSKI, KRISTA (RN, CNS)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:KLOSOWSKI
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6493 N NORTHWEST HWY APT 410
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1892
Mailing Address - Country:US
Mailing Address - Phone:616-217-6477
Mailing Address - Fax:
Practice Address - Street 1:6493 N NORTHWEST HWY APT 410
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1892
Practice Address - Country:US
Practice Address - Phone:616-217-6477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
IL041.389649163W00000X
IL164.008778133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No163W00000XNursing Service ProvidersRegistered Nurse