# FRESH AESTHETICS MEDICAL SPA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174105431
- **Authorized official:** ANGELA STANGER AGPCNP (OWNER/NP-C)
- **Authorized official phone:** (208) 358-3637

## Contact information

- **Practice address:** 1411 FALLS AVE E STE 105, TWIN FALLS, ID 83301-3455
- **Practice address phone:** (208) 358-3637
- **Mailing address:** 1411 FALLS AVE E STE 105, TWIN FALLS, ID 83301-3455
- **Mailing address phone:** (208) 358-3637

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/26/2021
- **Last updated:** 04/26/2021