Provider Demographics
NPI:1104979897
Name:KLOSTERMAN, MICHELLE R (RD, RN, PNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:KLOSTERMAN
Suffix:
Gender:F
Credentials:RD, RN, PNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:CHAUDOIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 16TH ST FL 5
Mailing Address - Street 2:PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2549
Mailing Address - Country:US
Mailing Address - Phone:415-476-5892
Mailing Address - Fax:415-476-1343
Practice Address - Street 1:1825 4TH ST FL 6
Practice Address - Street 2:PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2350
Practice Address - Country:US
Practice Address - Phone:414-353-2813
Practice Address - Fax:415-476-1343
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
CA95002982363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered