Provider Demographics
NPI:1699086025
Name:STANCEL, STEPHANIE TARA (CPNP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:TARA
Last Name:STANCEL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:TARA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1525 LAUREL CROSSING PKWY
Mailing Address - Street 2:APARTMENT 202
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6562
Mailing Address - Country:US
Mailing Address - Phone:770-364-4061
Mailing Address - Fax:
Practice Address - Street 1:3815 HARRISON RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2462
Practice Address - Country:US
Practice Address - Phone:770-466-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169676163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse