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General NPI Number Information
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NPI Number | 1780220517
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Entity Type | Organization
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Legal Business Name | RENEW AESTHETICS AND IV HYDRATION BAR
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Dates
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Enumeration Date | 11/27/2019
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Last Update Date | 11/27/2019
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Provider Practice Location Address
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Address Line | 515 N 4TH ST STE 2
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2927
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Country | US
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Telephone | 208-930-6823
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Fax |
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Provider Business Mailing Address
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Address Line | 3643 W PINERIDGE DR
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8094
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Country | US
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Telephone | 208-699-9470
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA ANN SATTLER
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Credential | RN
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Telephone | 208-699-9470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number |
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License Number State |
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