Individual
MR. EDWARD ROY VANDERBILT
Active
Individual
MR. EDWARD ROY VANDERBILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, APRN, FNP-C
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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