MEDICARE: JESSICA GRESKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2865M2000X	Military General Acute Care Hospital	R216550-3	MN

General Provider Information

NPI Number	:	1174912075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GRESKE

Provider Business Mailing Address
First Line	:	5375 EMERALD WAY
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-6673
Country	:	US
Telephone Number	:	763-218-7428
Fax Number	:

Provider Business Practice Location Address
First Line	:	5375 EMERALD WAY
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-6673
Country	:	US
Telephone Number	:	763-218-7428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “ JESSICA GRESKE ” Practice Location

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