Individual
KRISTEN MARY WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
25 MCCABE DR, RENO, NV 89511-5991
(775) 982-5000
(775) 982-3900
Mailing address
1155 MILL ST MS M14, RENO, NV 89502-1576
(775) 982-5262
(775) 982-3900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA988
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578570354
—
NV
Enumeration date
08/02/2006
Last updated
03/19/2025
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