Individual
MR. EDWARD ROY VANDERBILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, APRN, FNP-C
Contact information
Practice address
1304 ASHLEY SQ, WINSTON SALEM, NC 27103-2919
(336) 817-9268
(336) 396-8041
Mailing address
120 IVORHING CT, KERNERSVILLE, NC 27284-6335
(336) 817-9268
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5013618
NC
363LF0000X
Family Nurse Practitioner
Primary
5013618
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417553942
—
NC
Enumeration date
12/09/2020
Last updated
03/11/2025
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