Organization
RENEW AESTHETICS AND REGENERATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL LORAH (CHIEF EXECUTIVE OFFICER, CLINIC OWN)
(619) 669-8847
Entity
Organization
Contact information
Practice address
6302 112TH ST E STE 300, PUYALLUP, WA 98373-4315
(253) 651-9263
Mailing address
16616 139TH AVE E, PUYALLUP, WA 98374-8830
(619) 669-8847
Taxonomy
Speciality
Code
Description
License number
State
202D00000X
Integrative Medicine Physician
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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