Provider Demographics
NPI:1578819074
Name:VANDELLEN, STEPHANIE MONICA
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MONICA
Last Name:VANDELLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MONICA
Other - Last Name:KLUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5885 GLENRIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5573
Mailing Address - Country:US
Mailing Address - Phone:404-454-9715
Mailing Address - Fax:404-393-3739
Practice Address - Street 1:5885 GLENRIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5573
Practice Address - Country:US
Practice Address - Phone:404-454-9715
Practice Address - Fax:404-393-3739
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily