Provider Demographics
NPI:1730374430
Name:WISE, KRISTA ELIZABETH (APRN)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:ELIZABETH
Last Name:WISE
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-374-6162
Mailing Address - Fax:203-374-1549
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-374-6162
Practice Address - Fax:203-374-1549
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2014-01-15
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Provider Licenses
StateLicense IDTaxonomies
CT003479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily