Individual
SHANNON AMY KLOOSTERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TECHNICIAN
Contact information
Practice address
9714 SLIDING HILL RD, ASHLAND, VA 23005-7940
(252) 673-7736
Mailing address
9714 SLIDING HILL RD, ASHLAND, VA 23005-7940
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
24915
NC
Other
Enumeration date
07/25/2018
Last updated
07/25/2018
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