LAKESIDE AESTHETICS - LLC (NPI# 1851873756) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851873756 |
| Entity Type | Organization |
| Organization Name | LAKESIDE AESTHETICS - LLC |
| Other Organization Name | LAKESIDE MEDICINE AND AESTHETICS LLC |
| Practice Address |
1005 Highway 2 Sandpoint ID 83864-1702 |
| Mailing Address |
Po Box 333 Sagle ID 83860-0333 |
| Practice Telephone | 2082903302 |
| Mailing Telephone | 2082903302 |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2019-03-06 |
| Authorized Official Name | KELLY FUHRMAN (OWNER/NP) |
| Authorized Official Telephone | 2082903302 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
NP1029A | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | IDAHO STATE LICENSE NUMBER | NP1029A | 01 |
| Other Name | Type Code |
|---|---|
| Lakeside Medicine and Aesthetics LLC | Doing Business As Name - Organization |
| Street Address |
1005 HIGHWAY 2 |
| City | SANDPOINT |
| State | ID |
| Zip Code | 83864-1702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699802553 | Shawna Elisa Benner-erickson | Physical Therapist | 1005 Highway 2, Sandpoint, ID 83864-1702 | 2007-02-27 |
| 1184236143 | Jennifer J. Crew | Registered Nurse | 1005 Highway 2, Sandpoint, ID 83864-1702 | 2020-08-20 |
| 1093253940 | Erickson Pt Enterprises Pllc | Physical Therapist | 1005 Highway 2, Sandpoint, ID 83864-1702 | 2017-02-10 |
| 1750682605 | Kelly A. Fuhrman | Nurse Practitioner | 1005 Highway 2, Sandpoint, ID 83864 | 2010-11-09 |
| 1194939421 | John Mclain Faggard IIi | Specialist | 1005 Highway 2, Sandpoint, ID 83864-1702 | 2007-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144842600 | Deblaquiere Enterprises, Inc. | Pharmacy | 1319 Hwy 2, Suite A, Sandpoint, ID 83864 | 2020-05-07 |
| 1245867670 | Kimberly Sue Batchelder | Massage Therapist | Sandpoint Medical Massage & Bodyworks, LLC, 515 Pine Street Ste G., Sandpoint, ID 83864 | 2020-03-25 |
| 1699309963 | Ckam Rejuvenation Center LLC | Massage Therapist | 1315 Us-2, #5, Sandpoint, ID 83864 | 2020-02-26 |
| 1427602986 | Alpine Hand Therapy Inc | Physical Medicine & Rehabilitation | 1205 Hwy 2, Suite 102, Sandpoint, ID 83864 | 2019-08-01 |
| 1295388536 | Momentum Medical Massage and Personal Training, LLC | Massage Therapist | 1013 W Lake St, Sandpoint, ID 83864 | 2019-07-16 |
| 1629508932 | Karen Elizabeth Vollmer-poseley | Counselor | 506 N. 4th Ave, Sandpoint, ID 83864 | 2017-06-19 |
| 1760912042 | Gregory Jon Anthony Prins | Dentist | 1305 Highway 2 West, Sandpoint, ID 83864 | 2017-06-19 |
| 1730547084 | Charity Catlin | Midwife | 204 N 4th Ave #2355, Sandpoint, ID 83864 | 2016-02-02 |
| 1497148860 | Loftus Family Dental - Sandpoint Pllc | Dentist | 1310 Ponderosa Drive, Suite A, Sandpoint, ID 83864 | 2015-03-10 |
| 1215365523 | Tamarack Treatment and Counseling Center, Pllc | Counselor | 101 N. Boyer Ave, Sandpoint, ID 83864 | 2013-10-23 |
| Find all providers in zip 83864 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891308094 | Brandon Paul Kruse | Nurse Practitioner | 3345 S Fork Ave, Nampa, ID 83686-4855 | 2020-08-26 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1558986521 | Lisa Kay Stimpson | Nurse Practitioner | 1605 Poen Rd, Kuna, ID 83634-1743 | 2020-06-15 |
| 1730714049 | Care Medical Housecalls PC | Nurse Practitioner | 2040 E Holgate Ct, Eagle, ID 83616 | 2020-03-06 |
| 1295372308 | Elizabeth Balleweg | Nurse Practitioner | 2306 N 31st St, Boise, ID 83703-5628 | 2019-12-09 |
| 1891264545 | Tina Monique Bossolono-williams | Nurse Practitioner | 1385 Parkview Dr Ste 101, Twin Falls, ID 83301-4084 | 2018-11-23 |
| 1821525452 | Kristin Meshelle Hofmann | Nurse Practitioner | 420 W Main St Ste 206, Boise, ID 83702-7363 | 2017-05-14 |
| 1992237648 | Candice Elaine Adams | Nurse Practitioner | 5108 N Maidstone Way, Boise, ID 83713-1367 | 2017-03-31 |
| 1851832695 | Penny Rea | Nurse Practitioner | 5307 Green Valley Pl, Nampa, ID 83686-5790 | 2017-03-13 |
| 1891176798 | Christine Cooper | Nurse Practitioner | 35 W Idaho St, Weiser, ID 83672 | 2015-06-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.