Provider Demographics
NPI:1790301232
Name:KNETZER, MEGAN SAMANTHA (FNP)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:SAMANTHA
Last Name:KNETZER
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:12855 N 40 DR STE 375
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8657
Mailing Address - Country:US
Mailing Address - Phone:314-806-1770
Mailing Address - Fax:314-558-9017
Practice Address - Street 1:3 SAINT ELIZABETH BLVD STE 3900
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1282
Practice Address - Country:US
Practice Address - Phone:314-806-1770
Practice Address - Fax:314-558-9017
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021018970363LA2200X
IL209030918363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2021018970OtherNP LICENSE