Provider Demographics
NPI:1982911491
Name:VANDERBILT, ANNE (CNS, CNP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:VANDERBILT
Suffix:
Gender:F
Credentials:CNS, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # G10
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-3307
Mailing Address - Fax:216-445-8762
Practice Address - Street 1:9500 EUCLID AVE # G10
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-6801
Practice Address - Fax:216-445-8762
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-06130364S00000X
OH06130364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontologyGroup - Single Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist