Healthcare Provider Details

I. General information

NPI: 1316990971
Provider Name (Legal Business Name): VICTORIA J HAGSTROM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W 4TH ST
ST CHARLES MN
55972-2127
US

IV. Provider business mailing address

3143 SUPERIOR DR NW STE B
ROCHESTER MN
55901-2970
US

V. Phone/Fax

Practice location:
  • Phone: 507-932-3810
  • Fax:
Mailing address:
  • Phone: 507-258-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38191
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: