Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01085288A | IN |
NPI | 1003312422 |
---|---|
Provider Name | Katelyn Jule Klosterman |
First Address | Brownsburg, IN 46112-5618 |
Second Address | Indianapolis, IN 46260-1972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 26/07/2021 |