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General NPI Number Information
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NPI Number | 1558876284
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Entity Type | Organization
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Legal Business Name | VANISH PAIN & ALLERGY
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 207 W CLARENDON AVE STE 3
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City | PHOENIX
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State | AZ
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Zip | 85013-3447
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Country | US
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Telephone | 602-576-6770
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Fax | 602-535-4859
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Provider Business Mailing Address
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Address Line | 6807 W CARTER RD
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City | LAVEEN
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State | AZ
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Zip | 85339-7051
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Country | US
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Telephone | 602-576-6770
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Fax | 602-535-4859
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Authorized Official
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Title or Position | NURSE PRACTITIONER/ OWNER
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Name | TASHANA STEWARD
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Credential | NP-C
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Telephone | 602-576-6770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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