Healthcare Provider Details

I. General information

NPI: 1891624466
Provider Name (Legal Business Name): PRISTINE HEALTH LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WASHINGTON ST N STE 100
TWIN FALLS ID
83301-3874
US

IV. Provider business mailing address

844 WASHINGTON ST N STE 100
TWIN FALLS ID
83301-3874
US

V. Phone/Fax

Practice location:
  • Phone: 208-544-0070
  • Fax: 208-277-1166
Mailing address:
  • Phone: 208-544-0070
  • Fax: 208-277-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HAMANN
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential: FNP
Phone: 208-539-3858