Provider Demographics
NPI:1326109620
Name:KEGELMAN, MARY E (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:KEGELMAN
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 CHRISTINA LANDING DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5253
Mailing Address - Country:US
Mailing Address - Phone:757-593-2562
Mailing Address - Fax:
Practice Address - Street 1:CHAMPLAIN MILL, 20 WINOOSKI FALLS WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404
Practice Address - Country:US
Practice Address - Phone:302-530-8906
Practice Address - Fax:302-351-7388
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001079363LF0000X
VA0024166503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA95835OtherOPTIMA
VA010165512Medicaid
NC7003738Medicaid
VA007855G53Medicare ID - Type Unspecified
VA010165512Medicaid