Provider Demographics
NPI:1356615322
Name:WIEKAMP, CHRISTINA MARIE (ACNS-BC, CNP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:WIEKAMP
Suffix:
Gender:F
Credentials:ACNS-BC, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1575 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1126
Mailing Address - Country:US
Mailing Address - Phone:651-232-7163
Mailing Address - Fax:651-232-0201
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:2ND FLOOR WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-4408
Practice Address - Fax:612-775-4120
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN214163WP0000X, 207RH0002X, 208VP0000X
MN6650363L00000X
MN210007087364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist