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General NPI Number Information
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NPI Number | 1871734293
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Entity Type | Organization
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Legal Business Name | AESTHETIC CONCEPTS LLC
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 2860 CHANNING WAY STE 224
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7541
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Country | US
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Telephone | 208-529-6430
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Fax | 208-529-6428
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Provider Business Mailing Address
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Address Line | 2860 CHANNING WAY STE 224
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7541
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Country | US
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Telephone | 208-529-6430
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Fax | 208-529-6428
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Authorized Official
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Title or Position | OWNER NURSE PRACTITIONER
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Name | MS. LISA JUNE ZAJANC
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Credential | MSN FNP-C
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Telephone | 208-529-6430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP 669-A
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License Number State | ID
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