Healthcare Provider Details

I. General information

NPI: 1376763318
Provider Name (Legal Business Name): LAURA KLOSTERMAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 ESSEX PL
PATASKALA OH
43062-7561
US

IV. Provider business mailing address

284 ESSEX PL
PATASKALA OH
43062-7561
US

V. Phone/Fax

Practice location:
  • Phone: 614-975-8053
  • Fax:
Mailing address:
  • Phone: 614-975-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number21159964
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: