Provider Demographics
NPI:1457181703
Name:IGNITE PERFORMANCE NUTRITION, LLC
Entity type:Organization
Organization Name:IGNITE PERFORMANCE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGBEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CPT
Authorized Official - Phone:781-247-5022
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-0008
Mailing Address - Country:US
Mailing Address - Phone:781-247-5022
Mailing Address - Fax:
Practice Address - Street 1:17 CONANT DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4517
Practice Address - Country:US
Practice Address - Phone:781-247-5022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty