Provider Demographics
NPI:1881014249
Name:FJELLANGER, MEGAN NICOLE
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICOLE
Last Name:FJELLANGER
Suffix:
Gender:F
Credentials:
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 316
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63022-0316
Mailing Address - Country:US
Mailing Address - Phone:314-543-2800
Mailing Address - Fax:314-543-2801
Practice Address - Street 1:816 S KIRKWOOD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6056
Practice Address - Country:US
Practice Address - Phone:314-822-6830
Practice Address - Fax:314-822-6859
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014007467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily