Individual
KASSIDY ROSE NISSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23668 SCENIC DR., CRESTLINE, CA 92325-0661
(909) 227-1751
Mailing address
PO BOX 661, CRESTLINE, CA 92325-0661
(909) 227-1751
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
CA
Other
Enumeration date
03/13/2026
Last updated
03/13/2026
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