Provider Demographics
NPI:1114074150
Name:FENSTERMACHER, VICTORIA L (CFNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:FENSTERMACHER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 ROLLING RIDGE
Mailing Address - Street 2:CENTRACARE CLINIC BECKER
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308
Mailing Address - Country:US
Mailing Address - Phone:763-261-7000
Mailing Address - Fax:
Practice Address - Street 1:12800 ROLLING RIDGE
Practice Address - Street 2:CENTRACARE CLINIC BECKER
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308
Practice Address - Country:US
Practice Address - Phone:763-261-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0382048363LF0000X
MNR1395617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily