Healthcare Provider Details

I. General information

NPI: 1053981423
Provider Name (Legal Business Name): MEGAN J LAND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MEMORIAL DR STE W1
BELLEVILLE IL
62226-5359
US

IV. Provider business mailing address

3 SAINT ELIZABETH BLVD
O FALLON IL
62269-1281
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-3066
  • Fax:
Mailing address:
  • Phone: 618-233-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209023429
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021025641
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: