Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Edward Nicholas Waller, FNP-BC

Individual provider Family Nurse Practitioner · NPI 1124672118

Mr. Edward Nicholas Waller, FNP-BC is a Nurse Practitioner in Cambridge, Massachusetts. Qualified in 2019, 7 years ago. Practices with Massachusetts Institute of Technology, a 56-clinician group and accepts Medicare assignment. Licensed in Massachusetts.

Years since qualifying
7
Licensed in
MA
In the registry since
2019
What do these letters mean?
FNP-BC — Family Nurse Practitioner, Board Certified
A family nurse practitioner certified by the ANCC.

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Practice location Address checks out

25 Carleton St
Cambridge, MA 02142-1323
Phone: (617) 253-4481
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence RN2306059 (MA)

Record details

NPI number1124672118
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-BC
Sole proprietorNo
NPI enumeratedJuly 29, 2019
Last updated in NPPESJuly 29, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Massachusetts Institute Of Technology — 56 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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