NPIMap

Organization Active NPI

Skin Renaissance

  • Clinic/Center
  • Chesapeake, VA
National Provider Identifier
1962952275
Registry record updated Oct 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
0024170014 Issued in VA
Legal business name
SKIN RENAISSANCE
Practice address
312 Cedar Lakes Dr
Suite 103
Chesapeake, VA 23322-8374
Phone
(757) 410-2833
Fax
(757) 819-7591
NPI assigned
Oct 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Julie Foster Trask, R.N.
Title
Owner
Phone
(757) 410-2833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 0024170014 VA Primary

Addresses

Primary practice location

312 Cedar Lakes Dr
Suite 103
Chesapeake, VA 23322-8374

Mailing address

312 Cedar Lakes Dr
Suite 103
Chesapeake, VA 23322-8374
Phone (757) 410-2833

National Provider Directory

National Provider Directory

Locations

312 Cedar Lakes Dr
Ste 103
Chesapeake, VA 23322
Phone (757) 410-2833

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476144000000",
    "number": "1962952275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 CEDAR LAKES DR",
            "address_2": "SUITE 103",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233228374",
            "telephone_number": "757-410-2833",
            "fax_number": "757-819-7591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 CEDAR LAKES DR",
            "address_2": "SUITE 103",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233228374",
            "telephone_number": "757-410-2833",
            "fax_number": "757-819-7591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN RENAISSANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-11",
        "last_updated": "2016-10-11",
        "status": "A",
        "authorized_official_last_name": "TRASK",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "FOSTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-410-2833",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "VA",
            "license": "0024170014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.