Individual
KRISTINA MARY WAKEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
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
Update your record
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