Healthcare Provider Details

I. General information

NPI: 1255211892
Provider Name (Legal Business Name): BRIAN STEPHENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HAVANA ST
AURORA CO
80014-1618
US

IV. Provider business mailing address

9839 ELIZA CT
HIGHLANDS RANCH CO
80126-4720
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone: 303-338-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1623945
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: