Healthcare Provider Details

I. General information

NPI: 1063346617
Provider Name (Legal Business Name): FINNEGAN STUBSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 E 2ND ST
CASPER WY
82601-2926
US

IV. Provider business mailing address

1133 S WOLCOTT ST
CASPER WY
82601-4335
US

V. Phone/Fax

Practice location:
  • Phone: 307-577-7201
  • Fax:
Mailing address:
  • Phone: 307-277-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: