MEDICARE: MS. EILEEN EGAN APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	101.0138062	VT
2	363LA2200X	Adult Health Nurse Practitioner	101.0138062	VT
3	363LP2300X	Primary Care Nurse Practitioner	101.0138062	VT

General Provider Information

NPI Number	:	1700768785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EILEEN EGAN APN

Provider Business Mailing Address
First Line	:	165 SHERMAN DR
Second Line	:
City	:	ST JOHNSBURY
State	:	VT
Zip	:	05819-9811
Country	:	US
Telephone Number	:	802-748-9405
Fax Number	:	802-748-4540

Provider Business Practice Location Address
First Line	:	26 CEDAR LN
Second Line	:
City	:	DANVILLE
State	:	VT
Zip	:	05828-9751
Country	:	US
Telephone Number	:	802-684-2275
Fax Number	:	802-684-3839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	09/22/2025

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