1013468982 NPI number — ANN ELIZABETH KLOSTERKEMPER CNP

Table of content: ANN ELIZABETH KLOSTERKEMPER CNP (NPI 1013468982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013468982 NPI number — ANN ELIZABETH KLOSTERKEMPER CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLOSTERKEMPER
Provider First Name:
ANN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEIGEL
Provider Other First Name:
ANN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013468982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2158 INTELLIPLEX DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SHELBYVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46176-8548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-792-7800
Provider Business Mailing Address Fax Number:
513-792-4827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2158 INTELLIPLEX DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46176-8548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
174-211-9803
Provider Business Practice Location Address Fax Number:
317-398-1822
Provider Enumeration Date:
10/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  71007177A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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