Healthcare Provider Details

I. General information

NPI: 1619492709
Provider Name (Legal Business Name): VANISH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 01/30/2023
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 S HOWELL AVE STE 1600
OAK CREEK WI
53154-1460
US

IV. Provider business mailing address

7003 S HOWELL AVE STE 1600
OAK CREEK WI
53154-1460
US

V. Phone/Fax

Practice location:
  • Phone: 262-476-4900
  • Fax: 414-395-8925
Mailing address:
  • Phone: 262-439-9725
  • Fax: 414-395-8925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENISE ABERNETHY
Title or Position: PRESIDENT
Credential: MD
Phone: 262-476-4900