Organization
SKIN RENAISSANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE FOSTER TRASK R.N. (OWNER)
(757) 410-2833
Entity
Organization
Contact information
Practice address
312 CEDAR LAKES DR, SUITE 103, CHESAPEAKE, VA 23322-8374
(757) 410-2833
(757) 819-7591
Mailing address
312 CEDAR LAKES DR, SUITE 103, CHESAPEAKE, VA 23322-8374
(757) 410-2833
(757) 819-7591
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0024170014
VA
Other
Enumeration date
10/11/2016
Last updated
10/11/2016
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