| Skin Renaissance | |
|
312 Cedar Lakes Dr Suite 103 Chesapeake VA 23322-8374 | |
| (757) 410-2833 | |
| (757) 819-7591 |
| Full Name | Skin Renaissance |
|---|---|
| Speciality | Clinic/center |
| Location | 312 Cedar Lakes Dr, Chesapeake, Virginia |
| Authorized Official Name and Position | Julie Foster Trask (OWNER) |
| Authorized Official Contact | 7574102833 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Skin Renaissance 312 Cedar Lakes Dr Suite 103 Chesapeake VA 23322-8374 Ph: (757) 410-2833 | Skin Renaissance 312 Cedar Lakes Dr Suite 103 Chesapeake VA 23322-8374 Ph: (757) 410-2833 |
| NPI Number | 1962952275 |
|---|---|
| Provider Enumeration Date | 10/11/2016 |
| Last Update Date | 10/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962952275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0024170014 (Virginia) | Primary |
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