Provider Demographics
NPI:1528372943
Name:NEVAEH VEIN AND LASER MEDISPA
Entity Type:Organization
Organization Name:NEVAEH VEIN AND LASER MEDISPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:414-967-1716
Mailing Address - Street 1:103 E SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4702
Mailing Address - Country:US
Mailing Address - Phone:414-967-1716
Mailing Address - Fax:414-967-1781
Practice Address - Street 1:103 E SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-4702
Practice Address - Country:US
Practice Address - Phone:414-967-1716
Practice Address - Fax:414-967-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center