Provider Demographics
NPI:1659881522
Name:WIEMANN, KRISTAN KAY (RN)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:KAY
Last Name:WIEMANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTAN
Other - Middle Name:KAY
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4131 E SAN ANGELO AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-0332
Mailing Address - Country:US
Mailing Address - Phone:480-695-0053
Mailing Address - Fax:
Practice Address - Street 1:1020 S EXTENSION RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3420
Practice Address - Country:US
Practice Address - Phone:480-472-1200
Practice Address - Fax:480-472-1230
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN054753163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool