Provider Demographics
NPI:1285972653
Name:KLOSTER, DARBIE JO (LPN)
Entity type:Individual
Prefix:MRS
First Name:DARBIE
Middle Name:JO
Last Name:KLOSTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11798 JERDEN FALLS RD
Mailing Address - Street 2:
Mailing Address - City:CROGHAN
Mailing Address - State:NY
Mailing Address - Zip Code:13327-2610
Mailing Address - Country:US
Mailing Address - Phone:315-346-1014
Mailing Address - Fax:
Practice Address - Street 1:11798 JERDEN FALLS RD
Practice Address - Street 2:
Practice Address - City:CROGHAN
Practice Address - State:NY
Practice Address - Zip Code:13327-2610
Practice Address - Country:US
Practice Address - Phone:315-346-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-20
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311733-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse