MEDICARE: MRS. NICOLE DENISE KASTNER RN,MSN,CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	14131	CA

General Provider Information

NPI Number	:	1023051869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE DENISE KASTNER RN,MSN,CPNP

Provider Business Mailing Address
First Line	:	4617 SIERRA MORENA AVE
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92010-2836
Country	:	US
Telephone Number	:	760-729-2999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6475 ALVARADO RD
Second Line	:	SUITE #120
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5003
Country	:	US
Telephone Number	:	619-583-6133
Fax Number	:	619-583-0321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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