Provider Demographics
NPI:1023051869
Name:KASTNER, NICOLE DENISE (RN,MSN,CPNP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DENISE
Last Name:KASTNER
Suffix:
Gender:F
Credentials:RN,MSN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 SIERRA MORENA AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-2836
Mailing Address - Country:US
Mailing Address - Phone:760-729-2999
Mailing Address - Fax:
Practice Address - Street 1:6475 ALVARADO RD
Practice Address - Street 2:SUITE #120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5003
Practice Address - Country:US
Practice Address - Phone:619-583-6133
Practice Address - Fax:619-583-0321
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14131363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics