Provider Demographics
NPI:1295169290
Name:JESCH, MICHAEL JON (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JON
Last Name:JESCH
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 19TH ST S STE 101
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2154
Mailing Address - Country:US
Mailing Address - Phone:320-230-7788
Mailing Address - Fax:320-230-7789
Practice Address - Street 1:1900 GRASSLAND DR
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-6335
Practice Address - Country:US
Practice Address - Phone:605-995-4940
Practice Address - Fax:605-995-4942
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 1957363L00000X
NDR32294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner