JENNA LYNN MOSCHEROSCH (NPI# 1356653760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356653760 |
| Entity Type | Individual |
| Full Name | JENNA LYNN MOSCHEROSCH |
| Other Name | JENNA LYNN LAKUS |
| Credential | MS PAC |
| Practice Address |
5366 386th St Ne North Branch MN 55056-5833 |
| Mailing Address |
8170 33rd Ave S # Ms 21110q Minneapolis MN 55425-4516 |
| Practice Telephone | 6516748353 |
| Mailing Telephone | 9528538800 |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
11785 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
5601005802 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS IND | 1156321600 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5701 Bow Pointe Dr, Suite 100, Clarkston, MI 483463198 | 2486252621 | 2486258938 |
| 14701 Victor Hugo Blvd N, Hugo, MN 550384561 | 9528538800 |
| Street Address |
5366 386TH ST NE |
| City | NORTH BRANCH |
| State | MN |
| Zip Code | 55056-5833 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952885931 | Matthew Weiseman | Physician Assistant | 5366 386th St Ne, North Branch, MN 55056-5833 | 2018-09-17 |
| 1366893331 | Jena Labine | Nurse Practitioner | 5366 386th St Ne, North Branch, MN 55056-5833 | 2016-06-30 |
| 1497138465 | Joseph David Lahti | Pharmacist | 5366 386th St Ne, North Branch, MN 55056-5833 | 2015-07-08 |
| 1922486307 | Amy Carlson | Physical Therapist | 5366 386th St Ne, North Branch, MN 55056-5833 | 2015-05-18 |
| 1477964336 | Nicole Anderson | Registered Nurse | 5366 386th St Ne, North Branch, MN 55056-5833 | 2014-05-14 |
| 1972937506 | Tec LLC | Eyewear Supplier (Equipment, not the service) | 5366 386th St Ne, North Branch, MN 55056-5833 | 2013-08-30 |
| 1710321054 | Fairview Pharmacy Services LLC | Pharmacy | 5366 386th St Ne, North Branch, MN 55056-5833 | 2013-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306217146 | Joy Solano | Counselor | 38873 14th Ave North, North Branch, MN 55056 | 2015-10-19 |
| 1285072637 | Teresa Ann Dewitt | Registered Nurse | 9208 St Croix Trail, North Branch, MN 55056 | 2013-06-07 |
| 1396074209 | Twin Cities Mobile Chiropractic, P.C. | Clinic/Center | 6754 380th Circle, North Branch, MN 55056 | 2009-12-24 |
| 1811157662 | Shopko Stores Operating Co LLC | Pharmacy | 5630 St Croix Trail, North Branch, MN 55056 | 2008-06-16 |
| 1023171196 | Shawn Timothy Mccullough | Dentist | 6041 Main Street, Suite C, North Branch, MN 55056 | 2006-12-19 |
| 1518050103 | Paula J Rehder | Family Medicine | 6413 Oak Street, North Branch, MN 55056 | 2006-10-02 |
| 1699711614 | Julie A Perreault | Chiropractor | 6361 Main St, No Branch, MN 55056 | 2006-06-20 |
| 1760950307 | Kara H Mireles | Marriage & Family Therapist | 5842 Old Main St, Ste 2,3,4, North Branch, MN 55056 | 2018-11-12 |
| 1134614506 | Jenna Marie Leirmoe | Counselor | 38878 12th Ave, North Branch, MN 55056 | 2018-06-27 |
| 1689835647 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 5630 St Croix Trail, North Branch, MN 55056 | 2008-06-23 |
| Find all providers in zip 55056 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255969150 | Isaac Waalen | Physician Assistant | 5420 Circle Down, Minneapolis, MN 55416-1312 | 2020-03-28 |
| 1730643701 | Christina Jones | Physician Assistant | 11850 Blackfoot St Nw Ste 270, Coon Rapids, MN 55433-2593 | 2019-01-24 |
| 1114492964 | Molly Goss | Physician Assistant | 1817 Sunset Dr, Northfield, MN 55057-3246 | 2018-10-09 |
| 1932600160 | Ellen Kathryn Freeman | Physician Assistant | 111 Hundertmark Rd Ste 480, Chaska, MN 55318-1485 | 2018-02-22 |
| 1174041875 | Kristen Webb | Physician Assistant | 3931 Louisiana Ave S, Suite E-500, St. Louis Park, MN 55426 | 2017-09-01 |
| 1073051751 | Hannah Elizabeth Rosenthal Danielson | Physician Assistant | 640 Jackson St # Ms 11102m, Saint Paul, MN 55101 | 2017-02-02 |
| 1457893984 | Daniel Ryan Nguyen | Physician Assistant | 14551 Co Rd #11 #100, Burnsville, MN 55337 | 2016-11-15 |
| 1538545686 | Kathryn Jelle | Physician Assistant | 3931 Louisiana Ave S # 55426, St Louis Park, MN 55426-5000 | 2015-07-30 |
| 1831503267 | Karrah Oliver | Physician Assistant | 205 Roosevelt Ave W, Karlstad, MN 56732-4022 | 2014-06-13 |
| 1477981777 | Melissa Ferraz De Toledo | Physician Assistant | 9145 Springbrook Dr Nw Ste 300, Coon Rapids, MN 55433-5897 | 2013-10-23 |
| Find all providers with the same taxonomy | ||||
| City | NORTH BRANCH |
| Zip Code | 55056 |
Please comment or provide details below to improve the information on JENNA LYNN MOSCHEROSCH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.