Provider Demographics
NPI:1265478622
Name:WICKMAN, CRISTY H (CFNP)
Entity type:Individual
Prefix:MS
First Name:CRISTY
Middle Name:H
Last Name:WICKMAN
Suffix:
Gender:
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3345
Mailing Address - Country:US
Mailing Address - Phone:505-660-2404
Mailing Address - Fax:
Practice Address - Street 1:ONE SUN PLAZA, 110 SUN AVENUE
Practice Address - Street 2:SUITE 650
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01204363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP86557Medicare UPIN