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General NPI Number Information
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NPI Number | 1467485748
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Entity Type | Individual
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Provider Name | DIANE LIND FENSTER MD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 1715 DOUSMAN ST
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City | GREEN BAY
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State | WI
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Zip | 54303-3211
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Country | US
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Telephone | 920-496-4700
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Fax | 920-436-1349
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Provider Business Mailing Address
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Address Line | PO BOX 19070 PREVEA HEALTH
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City | GREEN BAY
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State | WI
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Zip | 54307-9070
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Country | US
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Telephone | 920-496-4700
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Fax | 920-436-1349
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 24154
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License Number State | WI
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