MEDICARE: KRISTA LEIGH KLOSTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	646008-1	NY

General Provider Information

NPI Number	:	1891359667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA LEIGH KLOSTER

Provider Business Mailing Address
First Line	:	7472 HODGE RD
Second Line	:
City	:	LOWVILLE
State	:	NY
Zip	:	13367-2331
Country	:	US
Telephone Number	:	315-681-0114
Fax Number	:

Provider Business Practice Location Address
First Line	:	6537 JOHNSON RD
Second Line	:
City	:	GLENFIELD
State	:	NY
Zip	:	13343-4120
Country	:	US
Telephone Number	:	315-783-9474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2019
Last Update Date	:	04/27/2019

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Directions to “ KRISTA LEIGH KLOSTER ” Practice Location

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