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General NPI Number Information
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NPI Number | 1548144777
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Entity Type | Organization
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Legal Business Name | IGNITE HORMONE AND WELLNESS
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 8985 W TONOPAH DR
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City | PEORIA
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State | AZ
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Zip | 85382-6443
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Country | US
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Telephone | 636-577-0105
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Fax |
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Provider Business Mailing Address
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Address Line | 8985 W TONOPAH DR
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City | PEORIA
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State | AZ
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Zip | 85382-6443
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Country | US
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Telephone | 636-577-0105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY BLANNER
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Credential | NP
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Telephone | 636-577-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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