Provider Demographics
NPI:1437315157
Name:VYVERBERG, STEPHANIE LEIGH (NP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:VYVERBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LEIGH
Other - Last Name:GIESEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1841 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4021
Mailing Address - Country:US
Mailing Address - Phone:404-728-4936
Mailing Address - Fax:
Practice Address - Street 1:1841 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4021
Practice Address - Country:US
Practice Address - Phone:404-728-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily