Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | 214 | MN |
N | 363L00000X | Nurse Practitioner | 6650 | MN |
NPI | 1356615322 |
---|---|
Provider Name | Christina Marie Wiekamp |
First Address | Maplewood, MN 55109-1126 |
Second Address | Minneapolis, MN 55407-3723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2012 |
Last Update Date | 04/07/2019 |