Healthcare Provider Details

I. General information

NPI: 1205408242
Provider Name (Legal Business Name): STEPHANIE R BRISON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE HOHN

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MESQUITE AVE
LAKE HAVASU CITY AZ
86403-5677
US

IV. Provider business mailing address

4070 COLUMBIA DR
LAKE HAVASU CITY AZ
86406-8011
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-0060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-85810
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number260734
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: