Provider Demographics
NPI:1780220517
Name:RENEW AESTHETICS AND IV HYDRATION BAR
Entity Type:Organization
Organization Name:RENEW AESTHETICS AND IV HYDRATION BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SATTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:208-699-9470
Mailing Address - Street 1:3643 W PINERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8094
Mailing Address - Country:US
Mailing Address - Phone:208-699-9470
Mailing Address - Fax:
Practice Address - Street 1:515 N 4TH ST STE 2
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2927
Practice Address - Country:US
Practice Address - Phone:208-930-6823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty