Provider Demographics
NPI:1669215364
Name:MORITZ, JESSICA LYN (CNP, WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYN
Last Name:MORITZ
Suffix:
Gender:F
Credentials:CNP, WHNP-BC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LYN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 HIGHLAND CT
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5976
Mailing Address - Country:US
Mailing Address - Phone:218-370-9706
Mailing Address - Fax:
Practice Address - Street 1:2945 HAZELWOOD ST STE 210
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1243
Practice Address - Country:US
Practice Address - Phone:651-770-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11694363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health