Provider Demographics
NPI:1275862401
Name:WISEMAN, CRISTINA MICHELLE (RN, MSN, CPNP, FNP-C)
Entity Type:Individual
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First Name:CRISTINA
Middle Name:MICHELLE
Last Name:WISEMAN
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Gender:F
Credentials:RN, MSN, CPNP, FNP-C
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8177 CLEARVISTA PKWY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1662
Practice Address - Country:US
Practice Address - Phone:317-621-7800
Practice Address - Fax:317-621-7805
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2017-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71003135A363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400058090Medicare PIN