Provider Demographics
NPI:1871734293
Name:AESTHETIC CONCEPTS LLC
Entity type:Organization
Organization Name:AESTHETIC CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:ZAJANC
Authorized Official - Suffix:
Authorized Official - Credentials:MSN FNP-C
Authorized Official - Phone:208-529-6430
Mailing Address - Street 1:2860 CHANNING WAY STE 224
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7541
Mailing Address - Country:US
Mailing Address - Phone:208-529-6430
Mailing Address - Fax:208-529-6428
Practice Address - Street 1:2860 CHANNING WAY STE 224
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7541
Practice Address - Country:US
Practice Address - Phone:208-529-6430
Practice Address - Fax:208-529-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 669-A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty