Provider Demographics
NPI:1760549463
Name:STUEMKE, MARK O (HEARING INSTRUMENT S)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:O
Last Name:STUEMKE
Suffix:
Gender:M
Credentials:HEARING INSTRUMENT S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 STATESVILLE BLVD
Mailing Address - Street 2:UNIT #3
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2280
Mailing Address - Country:US
Mailing Address - Phone:704-633-6775
Mailing Address - Fax:704-633-6799
Practice Address - Street 1:644 STATESVILLE BLVD
Practice Address - Street 2:UNIT #3
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2280
Practice Address - Country:US
Practice Address - Phone:704-633-6775
Practice Address - Fax:704-633-6799
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1270237700000X
NC386N02237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1270OtherNC STATE HEARING AID DEALERS & FITTERS BOARD