Provider Demographics
NPI:1235401464
Name:WENISCH, CRISTA B (ARNP)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:B
Last Name:WENISCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 NICOLLET AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5784
Mailing Address - Country:US
Mailing Address - Phone:952-898-1600
Mailing Address - Fax:
Practice Address - Street 1:14000 NICOLLET AVE STE 304
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5784
Practice Address - Country:US
Practice Address - Phone:952-898-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-117142363LF0000X
MNR217101-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily