Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4432 | MN |
N | 363LA2100X | Nurse Practitioner - Acute Care | AP60461334 | WA |
N | 363LA2100X | Nurse Practitioner - Acute Care | R120556-1 | MN |
NPI | 1043626047 |
---|---|
Provider Name | Patricia Ann Fenstermacher |
First Address | Red Wing, MN 55066-2848 |
Second Address | Red Wing, MN 55066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 05/10/2020 |