Provider Demographics
NPI:1881910776
Name:FENSKE, FADEKE JUSTINA (RN)
Entity type:Individual
Prefix:
First Name:FADEKE
Middle Name:JUSTINA
Last Name:FENSKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:FADEKEMI
Other - Middle Name:JUSTINA
Other - Last Name:FENSKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1285 70TH ST W
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-2305
Mailing Address - Country:US
Mailing Address - Phone:651-497-1602
Mailing Address - Fax:
Practice Address - Street 1:1285 70TH ST W
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-2305
Practice Address - Country:US
Practice Address - Phone:651-497-1602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN166158-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse