Individual
DR. YENNY ASTRID-ANGEL VANDERWAERDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-5416
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(980) 488-4900
(980) 488-4905
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
36309
SC
208M00000X
Hospitalist Physician
Primary
2016-01955
NC
208M00000X
Hospitalist Physician
36309
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363092
—
SC
01
—
P01364174
RAILROAD MEDICARE
SC
Enumeration date
12/19/2012
Last updated
09/19/2024
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