Provider Demographics
NPI:1518748524
Name:EST IV HYDRATION AND WELLNESS SPA PLLC
Entity Type:Organization
Organization Name:EST IV HYDRATION AND WELLNESS SPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EBONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-510-0182
Mailing Address - Street 1:9700 N 91ST ST STE A115
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9700 N 91ST ST STE A115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5036
Practice Address - Country:US
Practice Address - Phone:520-510-0182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care