Healthcare Provider Details

I. General information

NPI: 1235517822
Provider Name (Legal Business Name): MARK STENSTROM DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N EISENHOWER DR
JUNCTION CITY KS
66441
US

IV. Provider business mailing address

106 N EISENHOWER DR
JUNCTION CITY KS
66441-3314
US

V. Phone/Fax

Practice location:
  • Phone: 785-762-5631
  • Fax: 785-762-4371
Mailing address:
  • Phone: 785-762-5631
  • Fax: 785-762-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5634
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: