Healthcare Provider Details

I. General information

NPI: 1306770300
Provider Name (Legal Business Name): TREVOR WILLIAM STEPHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 BISHOP RANDALL DR
LANDER WY
82520-3939
US

IV. Provider business mailing address

4042 SAGE RD
CHEYENNE WY
82001-7600
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-4420
  • Fax:
Mailing address:
  • Phone: 307-421-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberN4764
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: