MEDICARE: LIBERTAS FAMILY MEDICINE PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1235900705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTAS FAMILY MEDICINE PC

Provider Business Mailing Address
First Line	:	210 1ST ST SE
Second Line	:
City	:	LITTLE FALLS
State	:	MN
Zip	:	56345-3004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 1ST ST SE
Second Line	:
City	:	LITTLE FALLS
State	:	MN
Zip	:	56345-3004
Country	:	US
Telephone Number	:	320-412-1310
Fax Number	:	833-428-6650

Authorized Official
Title or Position	:	CEO
Name	:	DR. JENNIFER WESENBERG
Credential	:	DO
Telephone Number	:	507-837-9873

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	05/01/2025

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