| Est Iv Hydration & Wellness Spa Pllc | |
|
9700 N 91st St Ste A115 Scottsdale AZ 85258-5036 | |
| (520) 510-0182 | |
| Not Available |
| Full Name | Est Iv Hydration & Wellness Spa Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9700 N 91st St Ste A115, Scottsdale, Arizona |
| Authorized Official Name and Position | Ebonique Thomson (OWNER/ FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 5205100182 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Est Iv Hydration & Wellness Spa Pllc 9700 N 91st St Ste A115 Scottsdale AZ 85258-5036 Ph: () - | Est Iv Hydration & Wellness Spa Pllc 9700 N 91st St Ste A115 Scottsdale AZ 85258-5036 Ph: (520) 510-0182 |
| NPI Number | 1518748524 |
|---|---|
| Provider Enumeration Date | 10/06/2023 |
| Last Update Date | 12/26/2024 |
| Medicare PECOS PAC ID | 7517496110 |
|---|---|
| Medicare Enrollment ID | O20250128001863 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518748524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Ebonique Thomson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003375825 PECOS PAC ID: 3870916760 Enrollment ID: I20250128002156 |
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