Basic Information
| Provider Information | |||||||||
| NPI: | 1356615322 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIEKAMP | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | ACNS-BC, CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1575 BEAM AVE | ||||||||
| Address2: | |||||||||
| City: | MAPLEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551091126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512327163 | ||||||||
| FaxNumber: | 6512320201 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 E 28TH ST | ||||||||
| Address2: | 2ND FLOOR WEST | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554073723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128634408 | ||||||||
| FaxNumber: | 6127754120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2012 | ||||||||
| LastUpdateDate: | 07/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0000X | 214 | MN | N | Nursing Service Providers | Registered Nurse | Pain Management | 207RH0002X | 214 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 363L00000X | 6650 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 364S00000X | 210007087 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 208VP0000X | 214 | MN | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.