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General NPI Number Information
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NPI Number | 1790301232
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Entity Type | Individual
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Provider Name | MEGAN SAMANTHA KNETZER FNP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2020
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 3 SAINT ELIZABETH BLVD STE 3900
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City | O FALLON
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State | IL
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Zip | 62269-1282
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Country | US
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Telephone | 314-806-1770
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Fax | 314-558-9017
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Provider Business Mailing Address
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Address Line | 12855 N 40 DR STE 375
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone | 314-806-1770
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Fax | 314-558-9017
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2021018970
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209030918
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License Number State | IL
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