Individual
KRISTEN ELIZABETH WISSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1725 NEW HANOVER MEDICAL PARK DR, WILMINGTON, NC 28403-5345
(910) 662-9300
(910) 662-2401
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5012734
NC
Other
Enumeration date
01/28/2020
Last updated
07/07/2021
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