Individual
JENNA LYNN MOSCHEROSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS PAC
Contact information
Practice address
5366 386TH ST NE, NORTH BRANCH, MN 55056-5833
(651) 674-8353
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
(952) 853-8800
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
11785
MN
363AM0700X
Medical Physician Assistant
5601005802
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1156321600
BCBS IND
MI
Enumeration date
07/14/2010
Last updated
03/17/2018
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