| Lakeside Medicine And Aesthetics Llc | |
|
1005 Highway 2 Sandpoint ID 83864-1702 | |
| (208) 290-3302 | |
| Not Available |
| Full Name | Lakeside Medicine And Aesthetics Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1005 Highway 2, Sandpoint, Idaho |
| Authorized Official Name and Position | Kelly Fuhrman (OWNER/NP) |
| Authorized Official Contact | 2082903302 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Medicine And Aesthetics Llc Po Box 333 Sagle ID 83860-0333 Ph: (208) 290-3302 | Lakeside Medicine And Aesthetics Llc 1005 Highway 2 Sandpoint ID 83864-1702 Ph: (208) 290-3302 |
| NPI Number | 1851873756 |
|---|---|
| Provider Enumeration Date | 09/06/2018 |
| Last Update Date | 03/06/2019 |
| Medicare PECOS PAC ID | 4688911464 |
|---|---|
| Medicare Enrollment ID | O20190201000669 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851873756 | NPI | - | NPPES |
| NP1029A | Other | ID | IDAHO STATE LICENSE NUMBER |
| Provider Name | Kelly A Fuhrman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750682605 PECOS PAC ID: 4981871597 Enrollment ID: I20141218000587 |
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