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General NPI Number Information
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NPI Number | 1366420150
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Entity Type | Individual
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Provider Name | VICTORIA FETTER M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 633 W WISCONSIN AVE STE 401
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City | MILWAUKEE
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State | WI
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Zip | 53203-1918
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Country | US
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Telephone | 414-272-4673
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Fax | 414-224-5457
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Provider Business Mailing Address
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Address Line | 6400 INDUSTRIAL LOOP
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City | GREENDALE
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State | WI
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Zip | 53129-2452
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Country | US
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Telephone | 411-423-4100
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Fax | 414-423-4134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 16473
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License Number State | WI
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