Healthcare Provider Details

I. General information

NPI: 1982518411
Provider Name (Legal Business Name): STEPHANIE STEPHENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 AIRPORT RD
RIFLE CO
81650-8510
US

IV. Provider business mailing address

501 AIRPORT RD
RIFLE CO
81650-8510
US

V. Phone/Fax

Practice location:
  • Phone: 970-625-6496
  • Fax:
Mailing address:
  • Phone: 970-625-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1627807
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: