Provider Demographics
NPI:1235517822
Name:STENSTROM, MARK (DVM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:STENSTROM
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-3314
Mailing Address - Country:US
Mailing Address - Phone:785-762-5631
Mailing Address - Fax:785-762-4371
Practice Address - Street 1:106 N EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441
Practice Address - Country:US
Practice Address - Phone:785-762-5631
Practice Address - Fax:785-762-4371
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5634174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian