Provider Demographics
NPI:1174841076
Name:MIESFELD, JESSICA L (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:MIESFELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:109 WARREN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3082
Mailing Address - Country:US
Mailing Address - Phone:920-885-3305
Mailing Address - Fax:920-885-5506
Practice Address - Street 1:109 WARREN ST
Practice Address - Street 2:STE 4
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3082
Practice Address - Country:US
Practice Address - Phone:920-885-3305
Practice Address - Fax:920-885-5506
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2014-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI57522-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100031865Medicaid