Provider Demographics
NPI:1801824909
Name:LAND, KAREN JANE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JANE
Last Name:LAND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-0160
Mailing Address - Country:US
Mailing Address - Phone:217-392-2108
Mailing Address - Fax:217-392-2110
Practice Address - Street 1:204 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:IL
Practice Address - Zip Code:62311-1228
Practice Address - Country:US
Practice Address - Phone:217-392-2108
Practice Address - Fax:217-392-2110
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA040943363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209010407Medicaid
IL208627014Medicare PIN
IL209010407Medicaid