Provider Demographics
NPI:1669402616
Name:PALUMBO, MARY VAL (DNP, APRN)
Entity type:Individual
Prefix:MS
First Name:MARY VAL
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 SOLAR WAY DR
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-9303
Mailing Address - Country:US
Mailing Address - Phone:802-847-1111
Mailing Address - Fax:
Practice Address - Street 1:792 COLLEGE PKWY
Practice Address - Street 2:FAHC MEMORY CENTER - SUITE 205
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3052
Practice Address - Country:US
Practice Address - Phone:802-847-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0015968363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1005787Medicaid
VTNP1283Medicare ID - Type Unspecified
R27237Medicare UPIN