Angela Stanger, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

67009 Issued in ID

Practice address

1411 Falls Ave E Ste 105
Twin Falls, ID 83301-3455

Phone

(208) 358-3637

NPI assigned

Dec 28, 2020

Last updated

Jan 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fresh Aesthetics Medical Spa

  • Gerontology Nurse Practitioner
  • Twin Falls, ID
  • NPI 1174105431
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610841600000",
    "number": "1013504836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 FALLS AVE E STE 105",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013455",
            "telephone_number": "208-358-3637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 FALLS AVE E STE 105",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013455",
            "telephone_number": "208-358-3637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANGER",
        "first_name": "ANGELA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-28",
        "last_updated": "2021-01-17",
        "certification_date": "2021-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "ID",
            "license": "67009",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "N-34627",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "info@freshskintf.com",
            "affiliation": "N",
            "address_1": "1411 Falls Ave E Ste 105",
            "city": "Twin Falls",
            "state": "ID",
            "country_code": "US",
            "postal_code": "833013455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• St. Luke's Magic Valley RMC-Lifeline
• Stacey Pound, LLC
• Miriam Joyce Staffen, LPC
• Douglas L Stagg, M.D.
• Donna Stalley, LCPC, LSW
• Justin Stanger, PHARMD
• Sandra Stanger, LCSW
• Julie Anne Stanton, RN
• Brad Q Starley, MD
• Amy M Starr, M.S., CCC-SLP

• Gerontology Nurse Practitioner in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Gerontology Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.