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General NPI Number Information
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NPI Number | 1265478622
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Entity Type | Individual
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Provider Name | CRISTY H WICKMAN CFNP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | ONE SUN PLAZA, 110 SUN AVENUE SUITE 650
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City | ALBUQUERQUE
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State | NM
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Zip | 87109
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 1227 SAN JOSE AVE
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City | SANTA FE
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State | NM
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Zip | 87505-3345
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Country | US
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Telephone | 505-660-2404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP01204
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License Number State | NM
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