Basic Information
| Provider Information | |||||||||
| NPI: | 1962689570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEGONIGAL | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5423 KILLENS POND RD | ||||||||
| Address2: | LAKE FOREST SCHOOL DISTRICT | ||||||||
| City: | FELTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199431901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026844950 | ||||||||
| FaxNumber: | 3026848931 | ||||||||
| Practice Location | |||||||||
| Address1: | 5423 KILLENS POND RD | ||||||||
| Address2: | LAKE FOREST SCHOOL DISTRICT | ||||||||
| City: | FELTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199431901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026844950 | ||||||||
| FaxNumber: | 3026848931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2008 | ||||||||
| LastUpdateDate: | 01/25/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WS0200X | L10020968 | DE | Y | Nursing Service Providers | Registered Nurse | School |
ID Information
| ID | Type | State | Issuer | Description | L10020968 | 01 | DE | STATE LICENSE | OTHER |