Provider Demographics
NPI:1548885478
Name:KESSNER, AMANDA ROSE (LM, CPM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:KESSNER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 STANNAGE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2006
Mailing Address - Country:US
Mailing Address - Phone:415-308-2848
Mailing Address - Fax:
Practice Address - Street 1:902 STANNAGE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2006
Practice Address - Country:US
Practice Address - Phone:510-679-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA610OtherMEDICAL BOARD OF CALIFORNIA