DR. KRISTINE ELIZABETH WIESE (NPI# 1073535977) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073535977 |
| Entity Type | Individual |
| Full Name | DR. KRISTINE ELIZABETH WIESE |
| Credential | M.D. |
| Practice Address |
2277 Highway 36 W Roseville MN 55113-3804 |
| Mailing Address |
Po Box 2182 Burnsville MN 55337-0008 |
| Practice Telephone | 6122550628 |
| Practice Fax Number | 6122550647 |
| Mailing Telephone | (612) 670-1321 |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2017-09-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084F0202X |
Psychiatry & Neurology Specialization: Forensic Psychiatry |
39360 | MN | Allopathic & Osteopathic Physicians |
| Street Address |
2277 HIGHWAY 36 W |
| City | ROSEVILLE |
| State | MN |
| Zip Code | 55113-3804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417305905 | Karol Jensen-schneider | Social Worker | 2277 Highway 36 W, Suite 310, Roseville, MN 55113-3804 | 2016-05-25 |
| 1609239797 | Laura Cosio | Marriage & Family Therapist | 2277 Highway 36 W, Suite 310, Roseville, MN 55113-3804 | 2016-04-05 |
| 1104206630 | Cimena Gordon | Social Worker | 2277 Highway 36 W, Suite 310, Roseville, MN 55113-3804 | 2015-05-29 |
| 1861879983 | Nicollette Erickson | Counselor | 2277 Highway 36 W, Suite 310, Roseville, MN 55113-3804 | 2015-04-27 |
| 1801163928 | Judith Marie Ellerbusch | Specialist | 2277 Highway 36 W, Roseville, MN 55113-3804 | 2011-11-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1467010330 | Ahmed Issa | Student in an Organized Health Care Education/Training Program | 1550 Larpenteur Ave W, Apt 235, St Paul, MN 55113 | 2019-06-05 |
| 1821653833 | Suite Living Senior Care of Little Canada | Assisted Living Facility | 2740 Rice Street, Little Canada, MN 55113 | 2019-05-06 |
| 1902370505 | Diverse Assessments and Treatment, LLC | Psychologist | 1935 Cty Rd B2 W Ste 270, Roseville, MN 55113 | 2019-01-16 |
| 1588138473 | Applewood Home Health Care, LLC | Home Health | 2021 E Hennepin Avenue # 402-1, Minneapolis, MN 55113 | 2019-01-14 |
| 1699251520 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2685 Patton Rd, Roseville, MN 55113 | 2018-07-13 |
| 1083104145 | Suite Living Senior Care of Roseville | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55113 | 2018-05-15 |
| 1477055796 | Sunrise Residential Services LLC | Home Health | 216 Maple Ln, Roseville, MN 55113 | 2018-03-02 |
| 1194223024 | Alissa Hoff | Specialist | 1595 Mn 36 - 584 10 Rosedale Center, Roseville, MN 55113 | 2018-01-25 |
| 1841705118 | Kingsland Care Services Incorporated | Case Management | 2301 Rice Street, Suite 101, Roseville, MN 55113 | 2017-12-08 |
| Find all providers in zip 55113 | ||||
| Taxonomy Code | 2084F0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Forensic Psychiatry |
| Forensic Psychiatry is a subspecialty with psychiatric focus on interrelationships with civil, criminal and administrative law, evaluation and specialized treatment of individuals involved with the legal system, incarcerated in jails, prisons, and forensic psychiatry hospitals. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831435007 | Carl Phillip Malmquist | Psychiatry & Neurology | 5010 Bruce Ave, Minneapolis, MN 55424-1318 | 2012-12-17 |
| 1407481591 | Marsha M Nelson | Psychiatry & Neurology | 270 Main St N Ste 300, Stillwater, MN 55082-6788 | 2020-03-09 |
| 1801312418 | Groundwork Psychiatry, LLC | Psychiatry & Neurology | 2419 Nicollet Ave, Minneapolis, MN 55404-3450 | 2017-08-15 |
| 1942688957 | Benjamin Gerndt Otopalik | Psychiatry & Neurology | 3301 7th Ave, Anoka, MN 55303-4516 | 2015-05-11 |
| 1639438575 | Matthew Reid Kruse | Psychiatry & Neurology | 3301 7th Ave, Anoka, MN 55303-4516 | 2012-05-13 |
| 1427234475 | Kyleeann Sophia Stevens | Psychiatry & Neurology | 100 Freeman Dr, Saint Peter, MN 56082-3504 | 2008-01-20 |
| 1518152172 | Frederick William Houts | Psychiatry & Neurology | 2419 Nicollet Ave, Minneapolis, MN 55404 | 2007-09-07 |
| 1003930124 | Mark Leon Willenbring | Psychiatry & Neurology | 360 Sherman St, Ste 100, Saint Paul, MN 55102-2564 | 2007-03-16 |
| 1841381910 | Jennifer Anderson Service | Psychiatry & Neurology | 1601 Saint Francis Ave, Suite 100, Shakopee, MN 55379-3383 | 2006-09-27 |
| 1760583140 | Ian James Heath | Psychiatry & Neurology | 1025 Marsh St, Mankato, MN 56001-4752 | 2006-09-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. KRISTINE ELIZABETH WIESE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.