Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | BP10049638 | TX |
N | 208000000X | Pediatrician | ML60551082 | WA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 60861 | AZ |
NPI | 1285051219 |
---|---|
Provider Name | Megan Elyse Land |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 10/12/2020 |