MEDICARE: MRS. MEGAN J LAND FNP

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	363LF0000X	Family Nurse Practitioner	2021025641	MO
2	363L00000X	Nurse Practitioner	209023429	IL

General Provider Information

NPI Number	:	1053981423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN J LAND FNP

Provider Business Mailing Address
First Line	:	3 SAINT ELIZABETH BLVD
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-1281
Country	:	US
Telephone Number	:	618-233-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 MEMORIAL DR STE W1
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5359
Country	:	US
Telephone Number	:	618-233-3066
Fax Number	:

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

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	01/12/2026

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