Provider Demographics
NPI:1700445392
Name:WISEL, CHRISTIE BRIANNA (MSTOM, DAOM)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTIE
Middle Name:BRIANNA
Last Name:WISEL
Suffix:
Gender:F
Credentials:MSTOM, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1201
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-1201
Mailing Address - Country:US
Mailing Address - Phone:907-987-3213
Mailing Address - Fax:
Practice Address - Street 1:907 THIRD AVE # B
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-4320
Practice Address - Country:US
Practice Address - Phone:907-987-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK146324171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist