Individual
KRISTINA MARY WAKEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
ST CLOUD HOSPITAL, 1406 6TH AVENUE NORTH, SAINT CLOUD, MN 56303-1901
(320) 251-2700
(320) 656-7115
Mailing address
ST CLOUD HOSPITAL, 1406 6TH AVENUE NORTH, SAINT CLOUD, MN 56303-1901
(320) 251-2700
(320) 656-7115
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8511
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356652861
BLUE CROSS BLUE SHIELD OF MN
MN
05
—
1356652861
—
MN
01
—
64-10926
SELECT CARE
MN
Enumeration date
06/30/2010
Last updated
05/29/2018
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