Provider Demographics
NPI:1669888905
Name:MOERTEL, JESSICA MARIE (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:MOERTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 HIGH POINT DR NE
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920-4407
Mailing Address - Country:US
Mailing Address - Phone:507-775-2128
Mailing Address - Fax:
Practice Address - Street 1:846 HIGH POINT DR NE
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MN
Practice Address - Zip Code:55920-4407
Practice Address - Country:US
Practice Address - Phone:507-775-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine