Healthcare Provider Details

I. General information

NPI: 1134354608
Provider Name (Legal Business Name): ELSA VICTORIA FIEBIGER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELSA VICTORIA HENNING

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 PARKLAWN AVE SUITE 200
EDINA MN
55435-5655
US

IV. Provider business mailing address

3955 PARKLAWN AVE SUITE 200
EDINA MN
55435-5655
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-4454
  • Fax:
Mailing address:
  • Phone: 952-831-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR-8637
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number56157
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: