Basic Information
| Provider Information | |||||||||
| NPI: | 1588801120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLOSTERMAN | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | ANNETTE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RONNEBERG | ||||||||
| OtherFirstName: | KRISTINA | ||||||||
| OtherMiddleName: | ANNETTE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 30575 BAINBRIDGE RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441392275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403686868 | ||||||||
| FaxNumber: | 4403686866 | ||||||||
| Practice Location | |||||||||
| Address1: | 6001 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132814400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP-10225 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | APRN.CNP.10225 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.