Healthcare Provider Details

I. General information

NPI: 1104979897
Provider Name (Legal Business Name): MICHELLE R KLOSTERMAN RD, RN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE R CHAUDOIR

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST FL 6 PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION
SAN FRANCISCO CA
94158-2350
US

IV. Provider business mailing address

550 16TH ST FL 5 PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION
SAN FRANCISCO CA
94158-2549
US

V. Phone/Fax

Practice location:
  • Phone: 414-353-2813
  • Fax: 415-476-1343
Mailing address:
  • Phone: 415-476-5892
  • Fax: 415-476-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95002982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: