| NPI | 1851873756 |
|---|---|
| Doing Business As | LAKESIDE MEDICINE AND AESTHETICS LLC |
| Entity Type | Organization |
| Authorized Contact | KELLY FUHRMAN Owner/Np 208-290-3302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: ID NP1029A) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2019-03-06 |