Individual
MS. KRISTINE GWEN WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
120 E JONES ST, SANTA MARIA, CA 93454-5101
(707) 304-0393
Mailing address
3057 S HIGUERA ST SPC 24, SAN LUIS OBISPO, CA 93401-6424
(707) 304-0374
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2024
Last updated
08/05/2025
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