MEDICARE: MORGAN LACEY HJELM 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	2021025129	MO
2	363LF0000X	Family Nurse Practitioner	209034564	IL

General Provider Information

NPI Number	:	1962175828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN LACEY HJELM FNP

Provider Business Mailing Address
First Line	:	1005 BROADWAY ST
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-2834
Country	:	US
Telephone Number	:	217-223-8400
Fax Number	:	217-277-3960

Provider Business Practice Location Address
First Line	:	100 MEDICAL DR
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-6877
Country	:	US
Telephone Number	:	573-221-5250
Fax Number	:	573-231-3716

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

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	06/16/2026

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