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General NPI Number Information
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NPI Number | 1306770300
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Entity Type | Individual
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Provider Name | TREVOR WILLIAM STEPHEN
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Gender | Male
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Dates
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Enumeration Date | 06/12/2026
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Last Update Date | 06/12/2026
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Provider Practice Location Address
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Address Line | 1320 BISHOP RANDALL DR
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City | LANDER
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State | WY
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Zip | 82520-3939
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Country | US
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Telephone | 307-332-4420
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Fax |
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Provider Business Mailing Address
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Address Line | 4042 SAGE RD
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City | CHEYENNE
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State | WY
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Zip | 82001-7600
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Country | US
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Telephone | 307-421-7002
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | N4764
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License Number State | WY
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