Healthcare Provider Details

I. General information

NPI: 1285343988
Provider Name (Legal Business Name): MARK STENSKE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 10/30/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 E ARAPAHOE RD UNIT 100
CENTENNIAL CO
80112-6814
US

IV. Provider business mailing address

2674 DEXTER ST
DENVER CO
80207-3050
US

V. Phone/Fax

Practice location:
  • Phone: 303-220-9168
  • Fax:
Mailing address:
  • Phone: 484-632-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012091
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: