Provider Demographics
NPI:1972086247
Name:RENEWED VITALITY & AGE MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:RENEWED VITALITY & AGE MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PALMITER
Authorized Official - Suffix:JR
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:804-412-8343
Mailing Address - Street 1:13141 EPPES FALLS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-1261
Mailing Address - Country:US
Mailing Address - Phone:804-412-8384
Mailing Address - Fax:
Practice Address - Street 1:13141 EPPES FALLS RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-1261
Practice Address - Country:US
Practice Address - Phone:804-412-8384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care