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General NPI Number Information
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NPI Number | 1326109620
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Entity Type | Individual
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Provider Name | MARY E KEGELMAN DNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | CHAMPLAIN MILL, 20 WINOOSKI FALLS WAY SUITE 400
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City | WINOOSKI
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State | VT
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Zip | 05404
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Country | US
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Telephone | 302-530-8906
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Fax | 302-351-7388
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Provider Business Mailing Address
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Address Line | 193 CHRISTINA LANDING DR
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City | WILMINGTON
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State | DE
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Zip | 19801-5253
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Country | US
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Telephone | 757-593-2562
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | LG-0001079
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024166503
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License Number State | VA
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