Individual
MR. JEFFREY LYNN VANDERBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
291 BROAD ST, KERNERSVILLE, NC 27284-2932
(336) 993-8181
(336) 996-9539
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
171504
NC
363L00000X
Nurse Practitioner
Primary
5012759
NC
Other
Enumeration date
04/08/2019
Last updated
10/26/2020
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