Provider Demographics
NPI:1952563363
Name:KLOOSTERMAN, KRISTEN JEAN (NP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JEAN
Last Name:KLOOSTERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5320 MILITARY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2149
Mailing Address - Country:US
Mailing Address - Phone:716-297-9379
Mailing Address - Fax:716-297-4638
Practice Address - Street 1:920 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3425
Practice Address - Country:US
Practice Address - Phone:716-242-8240
Practice Address - Fax:716-297-4638
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY420889363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health